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HEALTH  SCIENCES  STANpAFID 


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RA61 0  V26  Ifi'a"'  mortality  and 


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Ingen,  P»  V,  and  Taylor,  Emmons 
..•Infant  Mortality  and  Milk  Stations 

RA610-V26 


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i-^"lirt1inJi 


Columbia  (Bmtiem'tp 
mtljeCtlpotHmgork 

CoHese  of  ^f^v^icmna  anb  ^urgeonsi 


INFANT  MORTALITY 
AND  MILK  STATIONS 


SPECIAL  REPORT 

OF  THE  COMMITTEE  FOR  THE  REDUCTION 
OF  INFANT  MORTALITY  OF  THE 

NEW  YORK  MILK  COMMITTEE 


1912 


THE  NEW  YORK  MILK  COMMITTEE 

105  EAST  TWENTY-SECOND  STREET 

NEW  YORK 


Columtiia  Wini'btvJiitp 
CoUege  of  ^fjpgitiansJ  anb  burgeons 


l^eference  ILihvaxv 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/infantmortalitymOOvani 


INFANT    MORTALITY 
AND  MILK  STATIONS 


INFANT  MORTALITY 
AND  MILK  STATIONS 


SPECIAL  REPORT  DEALING  WITH 
THE  PROBLEM  OF  REDUCING 
INFANT  MORTALITY.  WORK 
CARRIED  ON  IN  TEN  LARGEST 
CITIES    OF    THE    UNITED    STATES 

TOGETHER   WITH 

DETAILS  OF  A  DEMONSTRATION  BY  PUBLIC 
AND  PRIVATE  AGENCIES  IN  NEW  YORK 
CITY  DURING  1911  TO  DETERMINE  THE 
VALUE  OF  MILK  STATION  WORK  AS  A 
PRACTICAL  MEANS  OF  REDUCING  INFANT 
MORTALITY 

D     n 

D 


Edited  by 
PHILIP  VAN  INGEN,  M.D. 

Member  of  the  New  York  Milk  Committee  and  Medical  Director  of  the  Committee  for  the 
Reduction  of  Infant  Mortality 

and 

PAUL  EMMONS  TAYLOR 

Secretary  of  the   New  York  Milk   Committee  and   Director  of  the   Committee    for    the 
Reduction  of  Infant  Mortality 


PUBLISHED    BY 

THE  NEW  YORK  MILK  COMMITTEE 

1912 


Infant  mortality  statistics  presented  in  this  report  were  prepared 
By  Philip  Van  Ingen,  M.D. 


Price,   One  Dollar 


The  New  York  Milk  Committee 

ORGANIZED  BY  THE  NEW  YORK  ASSOCIATION  FOR 

IMPROVING  THE  CONDITION  OF  THE  POOR  IN  1906 

INCORPORATED  IN  1910 

Create  ttjrougb  education  and  publicitp  a  public 
bemanb  for  a  clean  anb  jsafe  mtlfe  jiupplp  for 
an.    pretoent  unneces^ar?  XzH  of  infant  life. 

OFFICERS 
Stephen  G.  Williams,  Chairman 
Thomas  S.  McLane,  Vice-Chairman  and  Treasurer 
Paul  E.  Taylor,  Secretary 


ACTIVE  MEMBERS 
The  Officers  and 
Haven  Emmerson,  M.D. 
Stephen  Francisco 
Mrs.  J.  Borden  Harriman 
Philip  Van  Ingen,  M.D. 
Miss  Alice  Lakey 
Charles  E.  North,  M.D. 
Mrs.  a.  M.  Palmer 
Godfrey  R.  Pisek,  M.D. 
Marshall  L.  Warrin 
Ira  S.  Wile,  M.D. 


ADVISORY  COUNCIL 


E.  H.  Bartley,  M.D. 
Henry  Dwight  Chapin,  M.D. 
Henry  L.  Coit,  M.D. 
Henry  Ives  Cobb 
Lewis  A.  Conner,  M.D. 
Mrs.  Arthur  M.  Dodge 
Rt.  Rev.  David  H.  Greer 
A.  Jacobi,  M.D. 
Rev.  Walter  W.  Laidlaw 


Walter  W.  Law 
V.  EvERiT  Macy 
Franklin  D.  Roosevelt 
John  G.  Saxe 
DeWitt  J.  Seligman 
John  Spargo 
Mrs.  Henry  Villard 
Arthur  E.  Wakeman 
George  W.  Wickersham 


Committee  for  the  Reduction  of  Infant  Mortality 

Godfrey  R.  Pisek,  M.D.,  Chairman 
Mrs.  J.  Borden  Harriman,  Vice-Chairman 
Paul  E.  Taylor,  Director 


EXECUTIVE  COMMITTEE 
The  Officers  and 
S.  Josephine  Baker,  M.D. 
Eli  Long,  M.D. 
Mrs.  J.  J.  MooRHEAD 
Mrs.  a.  Gordon  Norrie 
E.  B.  Phelps 

Mrs.  Nathaniel  Bowditch  Potter 
Mrs.  Belmont  Tiffany 
Ira  S.  Wile,  M.D. 
Philip  Van  Ingen,  M.D. 


GENERAL 
Mrs.  Felix  Adler 
Reuel  a.  Benson,  M.D. 
Homer  Folks 
Miss  Alice  P.  Gannett 
Robbins  Oilman 
John  A.  Kingsbury 
Rev.  a.  W.  McCurdy 
Thomas  M.  Mulry 


COMMITTEE 

Prof.  M.  I.  Pupin 
Mrs.  V.  G.  Simkhovitch 
Miss  M.  deG.  Trenholm 
Morris  D.  Waldman 
Miss  Marianna  Wheeler 
Gaylord  S.  White 
Egerton  L.  Winthrop,  Jr. 


MEDICAL  COUNCIL 

Abraham  Jacobi,  M.  D.,  Chairman  L.  Emmett  Holt,  M.D. 

Walter  Lester  Carr,  M.D.  L.  E.  LaFetra,  M.D. 

Henry  Dwight  Chapin,  M.D.  C.  G.  Kerley,  M.D. 

Floyd  M.  Crandall,  M.D.  William  P.  Northrup,  M.D. 

Rowland  G.  Freeman,  M.D.  N.  R.  Norton,  M.D. 

S.  S.  GoLDWATER,  M.D.  JOHN  A.  Wyeth,  M.D. 


Table  of  Contents 

PAGE 

Introduction 

Chapter  I. — The  Problem 17 

Statistics  of  Infant  Mortality 

(a)  In  Foreign  Countries. 

(b)  In  the  Registration  Area  of  the  United  States. 
Conditions  Afifecting  Infant  MortaUty. 

Poverty  and  Ignorance,  Resulting  in — 

(a)  Unsanitary  Housing. 

(b)  Neglect  of  Babies  and  Expectant  Mothers. 

(c)  Impure  Milk. 

(d)  Bad  Methods  of  Feeding. 

(e)  Crime  and  Illegitimacy. 

Relation  of  Meteorological  Conditions  to  Infant  Mortality. 

Chapter  II. — The  Campaign  Against  Infant  Mortality  in  New  York 

City  (Prior  to  1911) 22 

Beginning  and  Growth  of  the  Movement. 
Work  of  Various  Charitable  Organizations. 
Work  of  the  Health  Department. 
Co-operation  Between  Organizations. 
Development  of  Prevention. 

Chapter  III. — The  Campaign  in  New  York  City  in  1911 27 

Work  of  the  New  York  Milk  Committee. 

(a)  EstabHshment  of  Thirty-one  Milk  Stations. 

(b)  Plan  of  the  Campaign. 

(c)  Tremendous  Growth  of  Movement. 

(d)  Appropriation  Granted  by  Board  of  Estimate  and  Apportionment  for  Fifty- 

five  Milk  Stations  in  191 2. 
Work  of  the  Health  Department. 
Work  of  Other  Organizations. 

Chapter  IV. — Results  of  the  Campaign  in  New  York  City  as  Shown  by 

Comparative  Tables 36 

A  Study  of  Infant  MortaUty  by  Years,  Trimesters,  etc.,  for  Manhattan,  Brooklyn, 

and  the  "Rest  of  the  City,"  Showing  Gross  and  Percentage  Changes. 
Weather  Conditions. 

Chapter  V. — Results  at  the  Milk  Stations  of  the  New  York  Milk 

Committee.    A  Statistical  Study  of  the  Records 52 

Comparison  of  Records  of  "Station"  Babies  and  "Station  District"  Babies. 
Feeding  Records  of  Station  Babies. 
Deaths  of  Station  Babies 


viii  TABLE  OF  CONTENTS 

PAGE 

Chapter  VI. — Campaigns  in  other  Cities 84 

Statistical  Study  of  Infant  Mortality. 

Weather  Conditions. 

Efforts  at  Reducing  Infant  Mortality. 

Chicago. 

Philadelphia. 

St.  Louis. 

Boston. 

Cleveland. 

Baltimore. 

Pittsburgh. 

Detroit. 

Buffalo. 

Chapter  VII. — General  Conclusions 122 

Summary  of  Infant  Mortality  in  Various  Cities. 
Comparison  of  Weather  Conditions  in  Various  Cities. 
Comparative  Summary  of  Campaigns  Against  Infant  Mortality. 
General  Deductions. 

Chapter  VIII. — ^The  Extension  of  Relief  Through  Milk  Stations.  ...   131 
Method  of  Handling  Free  Milk  Problems. 
Statistical  Study  of  Milk  Relief  Applications. 
Other  Forms  of  Relief. 

Ice. 

Hospital  Care. 

Outings. 

Conclusions. 

Chapter  IX. — Establishment  and    Operation  of   Milk  and   Health 

Stations 147 

Survey  of  Needs. 

Cost  and  Equipment  of  Station  Plants. 

Organization  and  Operation. 

Cost  of  Operation. 

Physicians. 

Nurses. 

Matrons. 

Chapter  X. — Extension  of  Milk  Stations'  Activities 165 

Education  of  Expectant  Mothers. 
Control  of  Midwives. 
Supervision  of  Boarded-out  Babies. 
Care  of  Children  Under  School  Age. 

Appendix 1 74 

Tables  Showing  the  Quality  of  Milk  Dispensed  by  the  Committee's  Stations  and  that 

Dispensed  by  City  Stations. 
Summary  of  Milk  Committee's  Work  for  Season. 

Exhibits 

Illustrations 


Introduction 

The  purpose  of  this  report  is  to  make  available  to  every  one  having  an  in- 
terest in  the  campaign  against  infant  mortality  the  information  acquired  by  the 
Committee  for  the  Reduction  of  Infant  Mortality  of  the  New  York  Milk  Com- 
mittee during  the  summer  of  1911,  when  it  undertook  a  demonstration  to  deter- 
mine the  value  of  infants'  milk  stations  as  a  means  of  reducing  that  mortality. 

It  is  not  intended  as  a  general  report  of  the  work  done  by  the  Committee, 
which  is  contained  in  the  Fifth  Annual  Report  of  the  New  York  Milk  Committee. 
Statistics  were  carefully  kept  and  tabulated.  They  are  here  presented,  with  the 
deductions  drawn  from  them,  together  with  the  opinions  derived  from  the  ex- 
perience of  those  who  organized  and  directed  and  carried  on  the  work. 

In  the  first  chapter  is  given  a  very  brief  summary  of  the  problem,  to  help  in 
the  solution  of  which  the  milk  station  was  called  upon.  A  frightful  tragedy, 
costing  the  lives  of  some  1600  men  and  women,  horrifies  the  entire  world,  and  yet 
every  year  many  thousands  of  babies  die  unnecessarily.  Tables  are  given  show- 
ing that  in  the  civilized  world  from  one  in  every  ten  to  one  in  every  three  babies 
born  die  during  the  first  year  of  life. 

The  various  factors  concerned  in  this  waste  of  life  are  very  briefly  discussed. 

In  the  next  chapter  is  given  a  resume  of  what  has  been  done  in  New  York 
city  during  recent  years  for  the  prevention  of  this  high  infant  mortality.  An 
attempt  is  made  to  trace  the  development  of  the  activities  working  together  today 
toward  this  end. 

Chapter  IV  deals  with  the  results  obtained  in  New  York  city  as  a  whole,  and 
its  different  subdivisions.  Tabulations  of  the  official  figures  of  the  Health  De- 
partment for  a  number  of  years  are  given.  These  tables  show  a  most  remarkable 
reduction  in  infant  mortality  for  the  year,  and  chiefly  during  the  summer  months. 
They  show  that,  with  a  low  total  infant  mortality,  only  28  per  cent,  occurred 
during  the  three  summer  months  in  Manhattan,  as  against  an  average  for  the 
preceding  ten  years  of  33.8  per  cent. 

A  tabulation  and  brief  discussion  of  weather  conditions  in  New  York  is  also 
given,  which  shows  that  in  the  first  half  of  the  summer  conditions  were  very  un- 
favorable for  a  low  infant  mortality.  The  first  part  of  July  was  the  most  un- 
favorable since  1901,  and  yet  the  deaths  during  that  month  were  the  lowest  since 
1901,  not  even  taking  into  consideration  the  increase  in  population. 

Chapter  V  deals  with  the  results  obtained  at  the  milk  stations.  Careful 
records  were  kept  containing  all  data  which  could  be  used  to  any  advantage. 
The  feeding  records  of  3182  babies  under  two  years  are  analyzed  and  studied  in 
some  detail.  Of  these  babies,  only  158  died,  and  of  them,  58  were  never  treated 
in  any  way  by  the  station  physician  or  nurses,  being  immediately  sent  to  a  hospital 


X  INTRODUCTION 

or  private  physician.  The  milk  stations  were  carried  on  to  prevent  sickness  among 
babies.  Many  facilities  exist  for  treating  sick  ones.  Every  baby  who  died,  how- 
ever, if  it  once  came  inside  the  station,  was  charged  against  that  station,  in  order 
to  avoid  possible  charges  of  selecting  cases.  The  results  show  the  entire  feasibility 
of  teaching  the  mother  to  modify  the  milk  at  home. 

Detailed  studies  of  mortality  in  a  large  portion  of  the  borough  of  Manhattan 
were  made  by  one  of  the  Committee,  in  order  to  try  to  show  the  relation  of  the 
mortality  among  the  station  babies  to  that  in  the  blocks  surrounding  th^  stations 
and  from  which  the  babies  came.     The  results  are  rather  striking. 

In  order  to  determine  whether  results  in  New  York,  especially  the  boroughs 
of  Manhattan,  wliere  the  Committee  was  working,  and  Brooklyn,  where  the 
Health  Department  was  most  active,  were  better  than  in  other  cities,  as  complete 
records  of  their  vital  statistics  as  possible  were  made,  together  with  an  attempt  to 
find  out  what  was  being  done  there.  The  nine  largest  cities  after  New  York  were 
selected.  More  could  not  be  attempted,  owing  to  the  difficulty  of  securing  in- 
formation. The  lack  of  published  statistical  records  makes  it  very  difificult  to 
make  a  thorough  study  of  conditions.  Comparatively  few  cities  outside  of  the 
largest  ones  publish  monthly  bulletins  of  vital  statistics.  Of  those  that  do, 
the  data  printed  in  regard  to  infant  deaths  are  often  scanty  and  classified  entirely 
differently  in  different  cities.  Even  the  Census  Bureau,  in  its  splendid  yearly 
reports  on  mortality,  does  not  tabulate  infant  deaths  by  months  of  occurrence, 
though  it  does  adults.  For  many  of  the  data  the  Committee  is  indebted  to  health 
officers,  who  supplied  them  on  written  request. 

In  Chapter  VI  the  various  data  collected  are  tabulated  and  summarized, 
and  an  attempt  is  made  to  compare  results  fairly  and  impartially.  The  Committee 
believes  the  value  of  the  milk  station  as  a  means  to  reduce  infant  mortality  through 
educational  prevention  is  proved. 

In  the  chapters  that  follow,  the  organization  of  the  stations  and  the  central 
office  is  shown  for  the  benefit  of  any  communities  planning  to  organize  such  a 
work.  The  cost  of  maintenance  is  most  carefully  and  fully  worked  out.  The 
problem  of  relief  and  the  details  of  its  management  are  given  fully.  A  chapter  is 
devoted  to  the  future  of  the  milk  station  and  its  possibilities  of  usefulness. 

The  work  of  the  Committee  was  carried  on  to  help  the  Department  of  Health 
demonstrate  the  value  of  milk  stations  in  reducing  infant  mortality.  The  city 
appropriated  funds  in  1910  to  maintain  15  municipal  milk  stations.  When  the 
Board  of  Estimate  and  Apportionment  met  to  pass  on  the  appropriations  for  1912, 
the  Committee  submitted  a  report  to  each  member  stating  what  had  been  ac- 
complished, and  illustrating  results  with  maps,  charts,  and  tables.  It  also  was 
represented  at  the  public  hearing  on  the  budget,  and  that  the  city  increased  the 
previous  appropriation  so  that  the  Department  of  Health  could  maintain  55  in 
1912,  they  feel  sets  the  official  seal  of  approval  on  the  work  of  milk  stations, — 
not  theirs, — but  what  is  far  more  important,  milk  stations  as  a  means  for  the  pre- 
vention of  infant  mortality  through  education. 

The  Committee  wishes  in  this  way  to  acknowledge  the  help  and  cooperation 
of  many — it  is  impossible  to  mention  them  by  name,  they  were  so  many.     The 


INTRODUCTION  xi 

various  relief  organizations,  settlements,  and  hospitals  gave  much  assistance; 
without  it  the  work  would  have  been  impossible.  The  cooperation  of  the  Health 
Department  and  the  Bureau  of  Municipal  Research  was  much  appreciated.  The 
ice  companies  did  their  share  in  generously  supplying  free  ice  to  those  unable  to 
buy  it. 

Our  thanks  are  due  to  the  many  health  officers  who  provided  statistical  ma- 
terial and  information.  Many  physicians  and  private  individuals  also  furnished 
valuable  information. 

And,  finally,  we  wish  to  express  our  thanks  and  appreciation  to  the  staff  of 
physicians,  nurses,  matrons,  and  the  office  force,  who  worked  in  season  and  out  of 
season,  early  and  late,  under  most  trying  and  almost  impossible  conditions,  giving 
their  very  best  to  their  work.  Without  such  a  spirit  on  the  part  of  all  we  could 
not  have  accomplished  what  we  did. 


I  And  U 
Thor 
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Boa 

I  NOISE 


'■->•  JH 


TO 

Commii 
Ma 
Keeii 


365  RULES  'FOR  THb  i.ARE 

OF  SICK  BABIES  IN  SUMMER 


DR.JACOBI  URGES 
CITY  TO  SAVE. 
LIVES  OF  BABIESI 

VcniTflble  Dean  of  American  Me  i 
Pleads  with  Board  of  Est  - 
— Mother  TclfsErenins  M;i  ij 
How  Pure  Milk  Has  Saved  I 


Exhibit  1 
How  Newspapers  Help 


CHAPTER  I 

The  Problem 

"A  baby  who  comes  into  the  world  has  less  chance  to  live  one  week  than 
an  old  man  of  ninety;   and  less  chance  to  live  a  year  than  one  of  eighty." 

So  said  Bergeron  some  years  ago,  and  it  is  practically  true  today.  In  1900, 
2.2  per  cent,  of  the  total  population  of  the  Registration  Area*  were  under  one 
year  of  age.  Assuming  the  same  proportion  to  hold  good  in  1910,  among  2.2  per 
cent,  of  the  population  occurredf  19.2  per  cent.,  or  nearly  one-fifth,  of  all  the 
deaths.  The  infantile  mortality  ratet  in  eight  States  having  fairly  complete 
birth  registration  varied  in  1910  from  108  to  168  (f) ;  that  is,  from  one  in  every 
six  to  one  in  every  ten,  babies  died  before  they  were  one  year  old. 

These  figures  are  not  exceptionally  high,  as  will  be  seen  from  the  following 
table  :§ 

TABLE    1.— SHOWING    GENERAL    AND     INFANT     DEATH-RATES    IN    FOREIGN 

COUNTRIES  IN  1909|| 

General  Death-rate  Infant  Death-rate 

England  and  Wales 14.5  109 

Scotland 15.3  121** 

Ireland 17.2  92 

New  South  Wales 9.6  74 

Victoria 11.2  71 

Queensland 9.7  72 

S.  Australia 9.3  61 

W.  Australia 9.9  78 

Tasmania 10.0  65 

New  Zealand 9.2  62 

Denmark 13.1  123** 

Norway 13.5  76** 

Sweden 13.7  85** 

Prussia 17.0  164 

Hungary 25.1  212 

Austria 22.3**  204tt 

Servia 29.3  158 

Netherlands 13.7  99 

Belgium 16.5**  147** 

France 19.3  135tt 

Switzerland 16.2**  108** 

Spain 23.4  173tJ 

Italy 21.4  153** 

Chili 31.5  320** 

*  The  registration  area  in  1900  comprised  40.5  per  cent,  of  the  population  of  continental 
United  States.  It  embraces  those  States  and  cities  which  have  adequate  laws  for  registration  of 
vital  statistics. 

t  Census  Bureau  Bulletin,  109. 

X  Infant  mortality  rate  is  deaths  of  infants  per  1000  living  births  for  same  period. 

§  From  Seventy-second  Annual  Report  of  Registrar  General  of  Births,  Deaths,  and  Marriages 
in  England  and  Wales  (1909). 

11  General  death-rate  is  number  of  deaths  at  all  ages  per  1000  of  population.  Infant  death- 
rate  is  number  of  deaths  under  one  year  per  1000  births. 

*♦  1908  figures.  ft  1907  figures.  %%  1906  figures. 

2  17 


1 8  INFANT  MORTALITY  AND  MILK  STATIONS 

Ireland,  Norway,  Sweden,  The  Netherlands,  and  the  great  Australian 
colonies.  New  Zealand  and  Tasmania,  alone  fall  below  100;  while  in  Prussia, 
roughly,  one  in  every  six;  Austria  and  Hungary,  one  in  every  five;  and  Chili, 
one  in  every  three,  babies  die  before  they  are  a  year  old. 

In  order  to  understand  the  problem  we  must  analyze  these  figues  still  further. 
It  is  necessary  to  know  when  the  babies  die,  and  from  what  causes.  The  follow- 
ing tables  show  the  age  at  death  and  the  cause  of  death  (general  groups  of  dis- 
eases) in  England  and  Wales  in  1909: 


TABLE  2— INFANT  MORTALITY  IN  ENGLAND  AND  WALES.     NUMBER  OF  DEATHS 
PER  1000  BIRTHS  AT  VARIOUS  AGES  AND  FROM  VARIOUS  GROUPS  OF 
DISEASES,  BASED  ON  FIGURES  FOR  1909* 


I.  Common  infectious  diseases 

II.  Diarrheal  diseases 

III.  Wasting  diseases 

IV.  Tuberculous  diseases 

V.  Miscellaneous 

All  causes 


Bi  ■< 


10.14 
1.41 


5z« 


.    0.04 
0.04  0.18  0.28 


10.68 
2.46 


11.55,13.18 


0.07 
0.30 
2.08 


3.823.16 
0.01  0.01|0.04 
1.69:1.84  1.50 


5.70|5.33i3.99 

I 


«  H  H 
O  Z  g 


0.11 
0.80 
29.88 
0.06 
8.90 


39.20 


Under  One  Year 


6.97,  or  6.4% 
12.64,  or  11.6% 
41.69,  or  38.3% 

4.00,  or  3.6% 
43.43,  or  39.9% 


infant  deaths 


108.73 


By  Months. 


1 

1-2 

2-3 

3-4 

4-5 

5-6 

6-7 

7-8 

8-9 

9-10 

10-11 

11-12 

Under 
1  Year 

I. 

0.11 

0.36 

0.36 

0.33 

0.32 

0.42 

0.54 

0.74 

0.85 

0.93 

0.97 

1.04 

6.97 

IL 

0.80 

1.47 

1.63 

1.50 

1.47 

1.23 

1.02 

0.89 

0.81 

0.72 

0.56 

0.54 

12.64 

III. 

29.88 

4.30 

2.35 

1.46 

1.02 

0.71 

0.52 

0.40 

0.32 

0.30 

0.23 

0.20 

41.69 

IV. 

0.06 

0.20 

0.32 

0.34 

0.44 

0.41 

0.38 

0.36 

0.40 

0.39 

0.35 

0.35 

4.00 

V. 

8.90 

5.26 

4.12 

3.44 

3.18 

2.93 

2.89 

2.76 

2.72 

2.58 

2.35 

2.30 

43.40 

All 

causes 

39.75 

11.59 

8.78 

7.07 

6.43 

5.70 

5.35 

5.15 

5.10 

4.92 

4.46 

4.43 

108.73 

I.  Includes  smallpox,  chicken-pox,  measles,  scarlet  fever,  diphtheria,  whooping-cough. 

II.  All  gastro-intestinal  diseases  except  gastritis  and  gastric  catarrh. 

III.  Includes  premature  births,  congenital  defects,  want  of  breast  milk,  starvation,  atrophy,  de- 
bility, marasmus. 


*  Compiled  from  Annual  Report  of  Registrar  General,  England  and  Wales,  1909.  It  should 
be  noted  here  that  in  Group  V  are  included  "meningitis,  not  tuberculous,"  and  "convulsions," 
which  amount  to  10.43  under  one  year,  and  "gastritis,  gastric  catarrh,"  amounting  to  1.83.  The 
latter,  in  our  classification,  would  probably  be  included  in  Group  II,  and  the  former  are  probably 
largely  digestive  in  character.  This  should  be  remembered  in  comparing  the  above  table  with 
Table  4. 


THE  PROBLEM 


19 


TABLE  3— INFANT  MORTALITY  IN  ENGLAND   AND  WALES.     PERCENTAGE 
TOTAL  DEATHS  UNDER  ONE  YEAR  OCCURRING  AT  VARIOUS  AGES, 
BASED  ON  FIGURES  FOR  1909 

Of  the  infant  deaths — 

10.6%  occurred  under  1  day. 


OF 


12.1%         ' 

'         1  day  and  less  than  1  week. 

5.2%        ' 

'         1  week   and  less  than  2  weeks. 

4.9%        ' 

'         2  weeks    "       "        "     3       " 

3.6%        ' 

'         3      "        "      "       "     1  month. 

36.5%        ' 

'         under  1  month  of  age. 

10.6% 

'           1  month  and  less  than    2  months 

8.0%        ' 

'           2  months  "       "       ' 

'       3 

6.5%        ' 

3        "        "      "       ' 

'       4 

5.9%        ' 

4        "        "      "       ' 

'       5       ' 

5.2%        ' 

5        "        "      "       ' 

'       6 

4.9%        ' 

6        "        

'       7       ' 

4.7%        ' 

7        "       "      "       ' 

'       8 

4.6%        ' 

8        "       "      "       ' 

'       9       ' 

4.5%        ' 

9        "        "      "       ' 

'     10       ' 

4.1%        ' 

10      '      ' 

'     11 

4.0%        ' 

11        "       "      "       ' 

'     12 

Of  these  deaths,  10.6  per  cent,  occur  under  one  day  old,  22,7  per  cent,  under 
one  week  old,  and  over  a  third  during  the  first  month  of  life.  From  then  on  the 
proportion  steadily  decreases.  The  above  tables  also  show  that  38.3  per  cent, 
of  these  deaths  under  one  year  occur  from  the  so-called  "wasting  diseases,"  and 
11.6  per  cent,  from  diarrheal  diseases.  As  noted  above,  the  proportion  of  the 
latter  is  probably  too  low,  but  practically  50  per  cent,  are  due  to  these  two  classes. 

The  following  table  shows  the  proportion  of  deaths  under  one  year  in  the 
Registration  Area  of  the  United  States  due  to  these  causes: 

TABLE  4.— PERCENTAGE  OF  DEATHS  UNDER  ONE  YEAR  OF  AGE  IN  THE  REGIS- 
TRATION AREA  OF  THE  UNITED  STATES  DUE  TO  DIARRHEAL 
AND  WASTING  DISEASE* 


1900-4 

Diarrhea  and  enteritis  (II) 23.72 

Wasting  disease  (III) 25.61 


49.33 


1905-9 
26.41 
27.79 

54.20 


1900-9 

25.23 
26.83 

52.06 


It  will  be  seen  that  in  the  United  States  also  a  little  over  one-half  of  all  the 
deaths  under  one  year  are  due  to  these  two  classes  of  disease.  Further,  the  pro- 
portion has  shown  a  steady  increase  from  year  to  year,  as  will  be  seen  from  the 
following  figures: 


TABLE  5.— PERCENTAGE  OF  ALL  DEATHS  UNDER  ONE  YEAR  DUE  TO  DIARRHEAL 

AND  WASTING  DISEASES  IN  THE  REGISTRATION  AREA 

OF  THE  UNITED  STATES* 


1900 48.80  per  cent. 

1901 48.40 

1902 47.57 

1903 49.96 

1904 51.84 


1905 52.46  per  cent. 

1906 53.21 

1907 54.23 

1908 55.59 

1909 55.03 


Such,  then,  in  brief  is  the  problem  which  confronts  us.     When  we  look  still 


*  " A  Statistical  Survey  of  Infant  Mortality's  Urgent  Call  for  Action,"  Phelps. 
for  Study  and  Prevention  of  Infant  Mortality,  Annual  Meeting,  1910. 


Amer.  Assoc. 


20  INFANT  MORTALITY  AND  MILK  STATIONS 

further  and  try  to  discover  the  causes  of  this  appalling  state  of  affairs,  we  are 
brought  face  to  face  with  practically  the  entire  social  problem  of  today. 

Conditions  Affecting  Infant  Mortality 

Ignorance  and  poverty  are  written  all  over  the  situation.  As  has  been  said, 
one-quarter  of  all  the  deaths  in  babies  are  due  to  the  so-called  "wasting  diseases." 
Poverty  forces  married  women  to  be  wage-earners.  It  forces  the  expectant 
mother  to  work  long  hours,  often  in  the  factory,  under  unsanitary  conditions, 
with  poor  food  and  with  her  family  at  home  to  take  care  of  after  working  hours. 
This  is  a  poor  preparation  for  the  ordeal  through  which  she  must  go.  She  is 
less  likely  to  give  birth  to  a  baby  who  has  a  fair  start  in  the  world.  Further,  her 
own  physical  condition  is  such  that  she  is  less  likely  to  be  able  to  give  the  baby 
the  food  that  nature  intended  it  to  have.  Even  if  she  can  give  the  baby  the 
breast,  poverty  again  drives  her  to  return  to  work  immediately  after  her  confine- 
ment. This  forces  her  not  only  to  feed  the  baby  artificially,  but  to  leave  it  to 
the  care  and  tender  mercies  of  a  "Little  Mother,"  often  a  mere  child  herself,  or 
to  confide  it  to  the  care  of  a  day  nursery. 

Poverty  forces  the  poor  to  live  in  overcrowded,  unsanitary  tenements. 
Exhibit  2  shows  graphically  the  distribution  of  infant  deaths  along  the  East  Side 
of  Manhattan — New  York  city.  In  some  of  these  blocks  as  many  as  5000  people 
are  herded  together,  and  it  is  in  these  districts  that  the  infant  deaths  occur  in 
such  large  numbers.  Compare  the  black  dots  near  the  river  with  those  near  Fifth 
Avenue.  We  are  here  confronted  with  the  problem  of  congestion  of  population 
in  all  its  phases. 

Another  quarter  of  the  deaths  among  babies  is  due  to  diarrheal  disease. 
This  means  bad  food  and  bad  methods  of  feeding.  Deprived  of  its  mother's 
milk,  the  baby  must  be  artificially  fed,  and  milk  should  be  the  chief  article  of 
diet  during  the  first  year.  This  brings  us  face  to  face  with  the  entire  milk  problem. 
How  is  the  city  to  be  insured  a  clean  milk  supply?  About  2,000,000  quarts  of 
milk  a  day  are  brought  into  New  York  city  from  44,000  farms  in  seven  different 
States.  To  the  average  mother  milk  is  milk.  She  is  ignorant  of  the  necessity 
for  clean,  pure  milk.  Poverty  forces  her  to  buy  the  cheapest  milk  she  can  get. 
Pure  milk  costs  more  to  produce  than  dirty  milk,  but  if  buying  food  for  the  older 
members  of  the  family,  she  would  not  willingly  buy  decomposing  meat  or  vege- 
tables. She  is  ignorant  of  the  fact  that  impure  milk  is  a  poison  to  her  baby,  just 
as  decomposing  food  is  to  the  rest  of  the  family. 

Bad  methods  of  feeding,  even  when  the  milk  used  is  a  good  milk,  are  respon- 
sible for  a  vast  number  of  deaths.  The  mother  is  ignorant  of  how  to  feed  her 
baby,  and  it  is  not  only  the  mother,  but  unfortunately  often  the  physician  as 
well,  who  is  ignorant.  When  her  baby  is  sickly,  in  desperation  she  tries  anything 
her  neighbors  suggest — condensed  milk,  proprietary  foods,  or  even  solid  food. 
Artificial  feeding  diminishes  tenfold  the  baby's  chance  to  survive  the  first  year. 

Finally,  crime  and  illegitimacy  come  in  as  causes.  The  figures  for  England 
and  Wales  for  1909  show  the  death-rate  among  illegitimate  children  under  one 
year  of  age  to  be  2U.1,  as  against  104.8  for  legitimate  children — more  than  twice 
as  high  a  mortality. 


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Exhibit  2 

A  Study  of  Death  Certificates  Shows  the  High  Infant  Mortality  Areas 

(Each  dot  represents  an  infant's  death  in  1910) 


WHERE  THE  BABIES  DIE  IN  BROOKLYN 

(Each  dot  represents  a  baby's  death  in  1910) 


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Exhibit  3 
In  Less  Than  One-half  of  Brooklyn's  Total  Area  Occurs  Ninety-five  Per  Cent,  of  the 

Borough's  Infant  Mortality 


THE  PROBLEM  21 

In  general,  then,  the  two  great  fundamental  causes  of  infant  mortality  are 
poverty  and  ignorance. 

Among  the  more  remote  causes  meteorologic  conditions  are  considered  to  play 
a  large  part  in  producing  infant  deaths.  From  one-third  to  almost  one-half  of 
the  baby  deaths  in  some  cities  are  recorded  during  the  third  quarter  of  the  year — 
July-September. 

In  a  recent  careful  study  of  conditions  in  Berlin  Lieflfmann  and  Lindemann 
have  drawn  certain  conclusions  as  to  the  effect  of  atmospheric  temperature. 
They  have  constructed  charts  showing  the  daily  deaths  in  Berlin,  together  with 
the  course  of  the  temperature  for  a  number  of  years.  They  show  that  for  the 
winter  and  spring  months  there  is  a  sort  of  normal  mean  daily  curve  for  deaths. 
In  early  summer,  with  the  advent  of  hot  days,  there  is  a  sharp  rise  in  the  number 
of  deaths;  with  the  fall  of  temperature  there  is  an  almost  immediate  fall  in  the 
deaths  to  the  so-called  normal.  In  midsummer  and  in  late  summer,  while  the 
sharp  rises  occur  with  each  hot  day,  the  fall  does  not  recur  to  the  "normal,"  but 
the  basal  curve  tends  to  remain  high.  It  is  only  after  a  considerable  period  of 
cool  weather  that  it  does  so  return. 

They  conclude,  from  their  studies,  that  atmospheric  heat  above  23°  C. 
(73.4°  F.)  has  a  directly  injurious  effect  upon  infants.  They  consider  that  a 
great  number  of  deaths  in  hot  weather  are  due  to  "heat-stroke"  ("Hitzschlag"), 
just  as  in  adults.  While  admitting  that  many  babies,  during  the  hot  weather, 
do  suffer  from  diarrheal  disease,  they  consider  that  this  is  not  the  real  cause  of 
death.  Artificial  feeding,  to  their  mind,  is  usually  faulty  in  quality  and  quantity 
in  hot  weather.  Cow's  milk  under  these  conditions  causes  an  injury  to  the 
intestinal  tract  which  makes  such  babies  particularly  susceptible  to  the  effects 
of  heat.     Certain  experiments  on  animals  seem  to  bear  out  this  theory. 

This  fact  seems  to  explain  the  failure  of  the  death-curve  to  return  to  the 
"normal"  in  later  summer  during  cooler  days.  Many  babies  die  from  diarrhea 
each  day,  regardless  of  the  temperature,  and  on  each  very  hot  day  the  "heat 
cases"  are  added. 

Whether  this  is  a  true  explanation  or  not;  whether  the  theory  that  the  heat 
diminishes  the  baby's  resistance,  acts  unfavorably  on  the  milk  or  food  it  gets,  and 
so  renders  it  an  easy  prey  to  the  diarrheal  disease  brought  on  by  faulty  feeding 
or  filthy  milk,  is  accepted — the  fact  is  not  altered  that  the  daily  deaths  do  rise 
sharply  in  hot  weather,  and  tend  to  remain  high  throughout  the  late  summer. 
Exhibits  4  and  5,  showing  the  daily  deaths  under  one  year  in  Manhattan  in  1909 
and  1910,  and  Exhibit  7,  showing  the  same  for  Brooklyn  for  1910,  illustrate  this 
very  clearly. 

Relative  humidity  has  been  less  studied,  and  it  is  somewhat  difficult  to  give 
its  proper  place.  It  is  to  be  noted  that  humidity  in  dwellings  is  probably  quite 
different  from  that  recorded  at  weather  bureaus. 

Rainfall — the  amount  and  distribution  of  the  rain  throughout  the  summer — 
is  thought  to  have  an  influence.  Dry  summers  and  long  periods  without  rain, 
even  when  the  total  rainfall  is  large,  are  supposed  to  increase  the  infant  mortality. 

All  these  factors  will  be  discussed  more  in  detail  in  studying  the  conditions 
and  results  in  1911  compared  with  other  years. 


CHAPTER  II 

History  of  the  Campaign  Against  Infant  Mortality  in 
Greater  New  York 

Before  describing  in  some  detail  the  story  of  the  campaign  in  New  York  in 
1911,  it  will  be  well  to  take  a  brief  glance  at  what  was  done  in  previous  years. 
The  New  York  Milk  Committee  is  convinced  that  the  phenomenal  decrease  in 
infant  mortality  in  1911  can  in  large  part  be  laid  to  improved  methods,  and  a  view 
of  the  development  of  these  methods  will  not  be  out  of  place. 

In  1873  the  New  York  Diet  Kitchen  Association  was  founded,  its  object 
being  to  distribute  nourishing  food  to  the  sick  among  the  very  poor.  "Good 
milk"  was,  of  course,  distributed  to  old  as  well  as  young. 

In  1891,  at  the  Good  Samaritan  Dispensary,  milk  was  dispensed  in  summer 
to  sick  babies.  It  was  modified  to  a  set  formula,  suited  to  a  definite  age,  and 
pasteurized.  For  several  years  this  part  of  the  work  was  carried  on  only  in  sum- 
mer.    Since  1898  it  has  distributed  milk  all  the  year. 

In  1892  Mr.  Nathan  Strauss  founded  his  well-known  Pasteurized  Milk 
Laboratories.  Any  baby  in  need  of  milk  could  obtain  the  day's  supply,  already 
prepared,  and  needing  only  to  be  warmed  before  using.  Mr.  Strauss's  depots 
were  situated  in  various  parts  of  the  city.  As  his  plan  grew  summer  stations 
were  added  to  meet  the  demand.  A  safe,  well-prepared  milk  was  provided,  the 
formulae  being  provided  by  the  best  medical  authorities  in  the  city.  This  was 
a  great  step  in  advance,  and  paved  the  way  for  most  later  developments. 

In  Brooklyn,  in  1901,  the  Children's  Aid  Society  entered  the  field,  following 
the  lines  of  the  Strauss  stations.  Their  depots  were  open  only  a  couple  of  months 
the  first  year  and  were  in  charge  of  a  matron.  The  Health  Department  provided 
a  physician  to  supervise  the  preparation  of  the  milk.  Eleven  stations  were  opened, 
chiefly  in  settlements  or  hospitals,  and  1087  babies  were  fed  the  first  summer. 
In  1889  and  1890  the  Brooklyn  Bureau  of  Charities  had  started  this  work,  which 
was  later  taken  over  by  the  above-mentioned  society. 

Before  1901  the  work  of  the  Health  Department  had  been  small  in  the  field 
of  infant  mortality.  As  far  as  the  annual  reports  show,  until  1902  it  consisted 
in  a  small  summer  corps  who  visited  sick  babies  in  the  tenements. 

In  1902,  however,  the  work  was  reorganized,  and  a  house-to-house  canvass 
of  the  worst  tenement  districts  was  carried  on.  Nurses  followed  up  the  cases  and 
carried  out  orders.  Dispensaries  were  established  at  recreation  piers;  206,121 
families  were  visited.  The  inspection  of  the  milk  supply  was  undertaken — at 
the  farm,  in  transit,  and  in  the  city.  Funds  were  not  available  for  a  very  exten- 
sive campaign,  but  the  work  was  begun. 

The  Brooklyn  Children's  Aid  Society  continued  their  work,  adding  another 


Exhibit  4 


Exhibit  5 


Exhibit  6 


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Exhibit  7 


Exhibit  8 


CAMPAIGN  AGAINST  INFANT  MORTALITY  23 

station,  and  caring  for  1197  babies.  This  year  they  were  open  from  June  24th 
to  September  5th.  The  same  general  principle  was  followed,  dispensing  milk 
according  to  age,  already  modified.  The  Henry  Street  Nurses'  Settlement  began 
this  year  to  dispense  milk  to  the  poor  in  their  neighborhood  in  connection  with 
their  visiting  work. 

In  1903  the  Health  Department  broadened  out  its  work  considerably. 
The  summer  corps  of  physicians  and  nurses  began  visiting  the  families  of  every 
baby  whose  birth  was  registered  with  the  department  between  August  1,  1902, 
and  June  30,  1903,  A  circular  on  "How  to  Keep  the  Baby  Well"  was  mailed 
to  each  address.  After  three  days  it  was  found  that  30  per  cent,  of  the  families 
had  moved,  and  so  many  unregistered  babies  were  found  that  a  house-to-house 
canvass  was  started,  and  a  report  made  on  every  child  under  one  year  found. 
Literature  was  distributed,  and,  when  necessary,  sick  babies  were  treated  by 
inspectors  and  nurses.  Six  inspectors  chosen  for  their  fitness  were  specially 
assigned  to  this.  In  Brooklyn  the  Children's  Aid  Society  increased  their  stations 
to  14,  feeding  1547  babies  from  June  17th  to  September  5th.  In  Manhattan  the 
Strauss  laboratories,  the  Good  Samaritan,  and  the  Diet  Kitchen  continued  their 
work  as  before. 

In  1904  the  department  continued  its  work  along  the  same  lines,  visiting 
the  tenement  districts,  tabulating  all  cases,  and  treating  the  sick  children.  The 
physicians  visited  159,726  families  and  treated  1428  sick  babies.  Thirty-three 
nurses  were  doing  district  work,  and  visited  56,271  families  and  cared  for  437 
sick  babies.  They  distributed  orders  for  milk  and  ice  as  needed.  In  Brooklyn 
the  Children's  Aid  Society  improved  on  their  method  by  attempting  seriously  to 
carry  on  some  instruction.  The  matrons  visited  among  the  sick  babies,  and  a 
corps  of  volunteer  physicians  (nine)  followed  up  the  sick  cases.  Again,  14 
stations  were  maintained  and  1233  babies  fed  from  June  27th  to  September  3d. 

In  1905  the  Health  Department  increased  its  activities,  employing  31  nurses 
in  Manhattan,  14  in  Brooklyn,  1  in  the  Bronx,  and  2  each  in  Queens  and  Rich- 
mond. The  families  visited  numbered  289, 1 14,  and  1985  sick  babies  were  treated. 
The  New  York  Diet  Kitchen  Association  had  been  paying  more  and  more  atten- 
tion to  babies  and  to  tuberculosis  work,  and  in  their  reports  only  milk  and  eggs 
are  mentioned  as  being  distributed.  In  Brooklyn  15  stations  were  maintained 
by  the  Children's  Aid  Society  from  June  26th  to  September  9th,  feeding  1649 
babies. 

In  1905  the  milk  problem  was  energetically  handled.  The  New  York 
Association  for  Improving  the  Condition  of  the  Poor  carried  on  a  very  extensive 
investigation  with  the  cooperation  of  the  Health  Department.  As  a  result  of 
this  investigation  many  violations  of  the  law  were  discovered  and  offenders 
punished.     It  was  the  beginning  of  a  vigorous  campaign. 

In  1906  a  new  agency  came  into  the  field.  Mr.  John  D.  Rockefeller  accepted 
the  suggestion  made  by  the  A.  I.  C.  P.  that  the  land  adjoining  the  Rockefeller 
Institute  be  utilized  for  a  summer  hospital  for  sick  babies,  where  mothers  could 
be  taught  that  they  can  "save  their  own  babies,  in  their  own  tenement  homes, 
if  they  will  give  them  clean  milk,  clean  air,  and  clean  bodies." 


24  INFANT  MORTALITY  AND  MILK  STATIONS 

The  old  Schermerhorn  mansion,  in  a  state  of  apparently  hopeless  decay, 
was  rejuvenated  by  soap  and  water  and  plenty  of  whitewash.  Five  open-air 
shacks  were  provided,  capable  of  accommodating  60  babies.  Everything  was 
of  the  simplest.  A  large  shelter  tent  was  provided,  and  "Junior  Sea  Breeze" 
was  ready  for  work.  Mothers  were  allowed  as  free  access  as  possible  to  the  shacks 
in  order  that  they  might  learn  that  the  simplest  articles  were  sufficient  to  care 
for  the  baby ;  also  how  much  had  to  be  done  when  a  baby  was  sick.  With  the 
hospital  work  proper  was  combined  an  educational  campaign.  In  the  shelter 
tent  there  were  given,  twice  a  week,  simple  lectures  and  demonstrations  to  the 
mothers  in  the  care  of  their  babies,  the  importance  of  maternal  nursing,  "clean 
milk,  clean  air,  clean  bodies."     A  nurse  did  follow-up  and  district  work. 

The  Health  Department  coiltinued  its  work  on  much  the  same  lines,  always 
increasing  in  amount:  350,618  families  were  visited,  and  3331  sick  children  treated. 
The  Children's  Aid  Society  in  Brooklyn  continued  as  before,  feeding  1620  babies 
at  its  15  stations  from  June  25th  to  September  8th.  There  was  little  change 
other  than  Junior  Sea  Breeze.  In  1906  the  appropriation  for  milk  inspectors  for 
the  Health  Department  was  doubled,  and  a  vigorous  inspection  was  carried  on. 

In  1906  the  New  York  Milk  Committee  came  into  existence  as  a  result  of  a 
conference  called  by  Dr.  Darlington,  then  Commissioner  of  Health.  This  com- 
mittee was  formed  to  investigate  the  milk  problem,  especially  in  its  relation  to 
infant  mortality.  The  Mayor  also  appointed  a  committee  to  investigate  the 
problem  of  insuring  a  safe  milk  supply. 

In  1907  the  work  of  the  Health  Department,  Diet  Kitchen,  Strauss  labora- 
tories. Good  Samaritan,  and  Children's  Aid  Society  of  Brooklyn  was  continued 
with  little  change.  The  chief  feature  of  the  summer  work  was  the  enlarging  of 
the  scope  of  the  work  of  Junior  Sea  Breeze.  A  very  vigorous  educational  cam- 
paign was  carried  on.  Nineteen  nurses  were  employed  in  district  work.  This 
work  was  confined  to  the  nineteenth  ward,  extending  from  Fortieth  Street  to 
Eighty-sixth  Street,  and  from  Sixth  Avenue  to  the  East  River.  A  house-to- 
house  canvass  of  the  district  was  made ;  mothers  were  urged  to  feed  their  babies 
on  wholesome  milk  if  nursing  was  impossible,  and  watch  was  kept  on  the  babies 
of  the  district.  It  was  a  piece  of  intensive  work  of  great  importance.  While 
the  summer  deaths  were  higher  in  the  rest  of  the  city,  in  the  nineteenth  ward  they 
were  lower  than  the  previous  year. 

The  Association  for  Improving  the  Condition  of  the  Poor  also  started  this 
summer  its  Caroline  Rest,  where  mothers  and  babies  were  sent  as  soon  after  the 
confinement  as  possible.  Here  the  mother  had  a  chance  to  recuperate  and  fit 
herself  to  nurse  her  baby.  She  was  given  the  most  careful  instruction  in  the  care 
of  babies  and  older  children. 

The  year  1908  marks  the  beginning  of  a  very  vigorous  campaign,  with 
emphasis  on  the  educational  factor.  Up  to  this  year  the  Department  of  Health 
had  carried  on  its  summer  corps  work  as  part  of  the  Division  of  Contagious 
Diseases.  In  August,  1908,  the  Division  of  Child  Hygiene  was  formed,  in  charge 
of  a  chief  and  5  assistant  chiefs,  16  supervising  inspectors,  1  superintendent  of 
nurses,  5  supervising  nurses,  and  195  district  nurses.     This  was  a  very  great  step 


CAMPAIGN  AGAINST  INFANT  MORTALITY  25 

in  advance.  The  summer  work  was  carried  on  by  83  nurses  and  20  doctors. 
Visits  were  made  to  all  new-born  babies  as  the  births  were  reported.  Lectures 
were  given  at  various  places  by  Health  Department  inspectors,  and  it  is  noticeable 
that  this  year  there  was  a  very  marked  decrease  in  infant  deaths  and  in  the 
infant  death-rate. 

Early  in  the  spring  the  Commissioner  of  Health  issued  an  invitation  to  all 
organizations  interested  in  any  way  in  the  campaign  against  infant  mortality 
to  attend  a  conference  at  the  Health  Department.  This  conference  was  held  and 
was  largely  attended,  and  the  cooperation  of  all  agencies  was  earnestly  asked  for. 
In  Brooklyn  the  department  increased  its  cooperation  by  detailing  inspectors 
and  nurses  to  the  stations  of  the  Brooklyn  Children's  Aid  Society.  The  work 
of  this  organization  was,  therefore,  greatly  increased,  and  the  educational  factor 
became  very  pronounced.  The  physicians  and  nurses  were  provided  with  simple 
medicines  which  were  given  to  any  sick  children.  From  their  16  stations  2296 
babies  were  fed.  Seventy  mothers'  meetings  and  clinics  were  held,  in  charge  of 
a  physician  and  nurse.  Literature  was  distributed  in  the  homes,  and  free  ice- 
tickets,  provided  by  the  Herald  Free  Ice  Fund,  were  given  when  needed. 

On  June  17,  1908,  the  New  York  Milk  Committee  opened  seven  stations, 
from  which  they  dispensed  milk  modified  at  the  stations  according  to  set  formulae. 
Volunteer  physicians  had  charge  of  all  the  consultations,  and  trained  nurses  were 
employed  to  prepare  the  milk  and  supervise  the  babies  in  their  homes.  No 
mother  was  permitted  to  obtain  milk  from  the  station  until  it  was  proved  that 
she  was  unable  to  nurse  her  baby,  and  she  was  allowed  to  obtain  milk  then  only 
on  condition  that  she  would  bring  her  baby  once  a  week  to  be  weighed  during 
consultation  hours.  A  careful  record  of  all  cases  was  kept  as  a  basis  for  further 
work.  From  three  of  the  depots  pasteurized  milk  was  dispensed,  and  from  four, 
raw  milk.  Consultations  were  also  held  at  the  Union  Settlement  in  East  One 
Hundred  and  Fifth  Street  and  in  West  Ninety-third  Street,  though  milk  was  not 
dispensed  from  these  places.  Junior  Sea  Breeze  continued  its  work  as  in  the  past 
year,  although  not  so  many  nurses  were  employed  in  visiting  work  as  in  the 
previous  year. 

In  1909  the  work  of  the  Division  of  Child  Hygiene  was  increased.  It  was 
made  to  include  the  supervision  of  midwives,  boarded-out  children,  nurseries, 
and  other  institutions  caring  for  children.  From  April  15th  to  September  1st 
the  summer  campaign  was  carried  on.  A  great  step  in  advance  was  made  by 
beginning  the  campaign  early.  The  summer  corps  visited  57,059  mothers  of 
new-born  infants. 

Another  important  step  in  advance  was  the  formation  of  the  so-called 
"Little  Mothers*  League."  There  were  54  centers  for  this  league,  which  enrolled 
the  little  mothers  in  the  public  schools,  giving  them  lessons  and  demonstrations 
in  the  care  of  the  baby  and  general  hygiene.  An  inspector  and  a  nurse  held 
these  meetings  once  or  twice  weekly  in  each  center.  The  New  York  Milk  Com- 
mittee maintained  seven  stations  throughout  the  year.  This  organization  was 
originally  a  special  committee  of  the  New  York  Association  for  Improving  the 
Condition  of  the  Poor.     In  October  of  this  year  it  became  an  independent  organ- 


26  INFANT  MORTALITY  AND  MILK  STATIONS 

ization,  in  accordance  with  the  poHcy  of  the  Association  in  allowing  its  offspring 
to  become  independent  as  soon  as  they  were  able  to  care  for  themselves. 

In  Brooklyn  the  Children's  Aid  Society  continued  its  cooperation  with 
the  Health  Department.  Sixteen  stations  were  maintained,  caring  for  2142 
babies.  Physicians  and  nurses  w^ere  provided  by  the  Health  Department,  and 
there  was  also  cooperation  by  the  District  Nursing  Committee.  Increased 
emphasis  was  laid  on  educational  work,  maternal  nursing,  and  the  care  and 
preparation  of  milk.     Three  hundred  and  twenty  meetings  were  held  during  the 

year. 

In  1910  the  work  continued  as  before.  The  New  York  Milk  Committee  was 
able  to  maintain  only  four  stations,  owing  to  lack  of  funds.  These  were  con- 
ducted also  along  different  lines.  The  distribution  of  already  modified  milk 
was  discontinued,  and  the  policy  of  teaching  mothers  to  prepare  the  baby's  food 
themselves,  under  the  supervision  of  the  nurse,  according  to  the  doctor's  direc- 
tion, was  carried  out.  It  was  with  considerable  hesitation  that  this  work  was 
undertaken,  but  the  results  soon  proved  its  value.  The  mothers  were  more 
regular  in  their  attendance,  and  took  greater  personal  interest  and  pride  in 
the  progress  of  their  babies  when  they  themselves  prepared  the  food.  During 
this  year  the  Health  Department  cooperated  with  the  New  York  Diet  Kitchen, 
providing  physicians  and  nurses  for  eight  of  their  nine  stations.  The  ninth 
station  was  managed. by  the  association  itself.  Physicians  and  nurses  held  at 
first  weekly  clinics,  then  semi-weekly,  and,  finally,  during  the  summer,  daily 
clinics.  Expectant  mothers  were  also  cared  for.  In  Brooklyn  the  Children's 
Aid  Society  continued  as  before.  The  importance  of  small  classes  and  individual 
instruction  was  brought  home  to  them,  and  greater  attention  was  paid  to  this 
detail.  From  18  stations  2182  babies  were  fed,  of  whom  half  were  sick  on  admis- 
sion, and  only  32  deaths  occurred. 

It  will  be  noticed  that  of  late  years,  especially  since  1908,  prevention  has 
been  playing  a  greater  and  greater  part  in  the  attempts  at  the  reduction  of  infant 
mortality.  What  has  been  given  above  is  merely  a  very  brief  outline  of  certain 
phases  of  the  work  which  has  been  carried  on.  It  is  impossible  to  give  in  detail 
everything  that  has  been  done.  One  of  the  most  important  agencies  in  the  pre- 
vention of  the  waste  of  infant  lives  has  been  the  adoption  of  the  so-called  social 
service  work  of  Dr.  Cabot,  of  Boston.  Most  of  the  hospitals  and  dispensaries  of  this 
city  now  have  a  social  service  department.  It  interests  itself,  among  other  things, 
with  the  care  of  babies  and  the  prevention  of  disease  among  them.  Another 
very  important  step  has  been  the  increasing  cooperation  developing  among 
various  agencies.  The  Health  Department  has  been  ready  and  willing  to  make 
the  work  which  is  being  done  in  every  way  more  efficient.  In  1907  the  depart- 
ment turned  over  practically  all  the  work  of  visiting  new-born  babies  in  the 
nineteenth  ward  to  Junior  Sea  Breeze  Hospital.  A  list  of  births  was  provided 
to  the  Junior  Sea  Breeze  nurses,  just  as  to  their  own.  This  cooperation  increased 
in  a  most  encouraging  way,  as  will  be  seen  in  the  report  of  what  has  been  done 
in  1911. 


NEW  YORK  MILK  COMMITTEE 


EXECUTIVE      COHnilTEE 


CQMMSREDUffl'IfflTtlDRlJIY 


HNANCE 
COMMITTEE 


EXECUTIVE    COMMITTEE 


MEDICAL 
COUNCIL 


DIRECTOR 

I 


REUEFAGEMT 


SUPERVISE 
NURSE 


AS  ST.  SUP. 
NURSE 


SECRETARY  TO 
UIRECTDR 
1 


STATISTICAL 
CLERKS 


BOOK-KEEPER  _ 


TELEPHOME 
DPERATER 


SPECIAL 
NURSES 


INVESTIGATORS 


MESSENGERS 


GENERAL 
COMMinEE 


VOLUNTEEK 
SUPERVISING 
PHYSICIAN 


STATION 
PHYSICIANS 


STATION 
NURSES 


INTERPRETERS     ASSISTANTS 


MATRONS 


Exhibit  9 
Organization  Chart  of  the  Committee  for  the  Reduction  of  Infant  Mortality  of^the 

New  York  Milk  Committee 


CHAPTER  III 

The  Campaign  in  New  York  City  in  1911 

The  year  1911  marks  the  beginning  of  the  most  extensive  and  efficient 
campaign  for  the  reduction  of  infant  mortaUty  ever  undertaken  in  New  York 
city.  The  lessons  of  past  years  had  apparently  been  learned.  Here  were  a 
number  of  organizations,  each  working  independently,  with  practically  no  general 
cooperation,  though  many  worked  well  with  the  Health  Department. 

Campaign  of  the  New  York  Milk  Committee 

In  the  fall  of  1910  the  Board  of  Estimate  and  Apportionment  appropriated 
sufficient  funds  to  maintain,  during  the  entire  year,  15  infants'  milk  depots  under 
city  control.  These  stations  were  put  under  the  control  of  the  Division  of  Child 
Hygiene.  The  New  York  Milk  Committee  realized  that  this  was  a  new  venture, 
and  that  the  extension  of  this  system  of  milk  depots  depended  on  the  success 
of  the  year's  work.  They  also  realized  that  the  summer  months  were  the  ones 
when  the  greatest  reduction  ought  to  be  obtained.  To  make  the  experiment  a 
strongly  convincing  one,  a  sufficiently  large  number  of  stations  must  be  provided 
to  cover  thoroughly  a  large  portion  of  the  city.  The  Health  Department  decided 
to  place  only  five  in  Manhattan,  one  in  the  Bronx,  and  nine  in  Brooklyn.  It 
was  felt  that  the  mortality  of  the  city  could  not  be  demonstrably  affected  by  the 
existing  stations,  so  a  subcommittee  of  the  New  York  Milk  Committee,  known  as 
the  Committee  for  the  Reduction  of  Infant  Mortality,  was  formed.  They  were 
authorized  to  plan  a  campaign,  raise  money,  and  conduct  their  demonstration, 
subject  to  the  approval  of  the  Executive  Committee  of  the  parent  body. 

The  new  subcommittee  selected  an  Executive  Committee  and  a  Finance 
Committee.  The  former  committee  thoroughly  canvassed  the  city,  studying 
the  available  records  of  population  and  mortality,  and  the  presence  of  other 
similar  organizations  in  given  districts.  As  a  result  of  this  study  it  was  decided 
to  start,  as  soon  as  funds  could  be  raised,  22  stations,  in  addition  to  the  4  already 
maintained  by  the  Committee.  It  was  thought  that  these  stations  could  care 
for  most  of  the  worst  portions  of  the  city. 

The  Finance  Committee  started  in  on  a  whirlwind  campaign.  The  city 
was  divided  into  districts,  each  district  being  in  charge  of  a  leader.  Mrs.  J. 
Borden  Harriman  was  chairman  of  the  Committee,  and  she  associated  with  her 
a  number  of  prominent  and  active  women  as  district  leaders.  Each  district 
leader  divided  her  district  into  streets,  and  appointed  a  street  leader  for  each. 
These  latter  approached  the  residents  in  their  vicinity  with  a  personal  letter  of 
appeal.     The  result  was  quite  startling.     The  financial  campaign  did  not  start 

27 


28  INFANT  MORTALITY  AND  MILK  STATIONS 

until  April,  but  enough  money  was  obtained  to  open  11  stations  of  the  22  on  the 
second  of  May.  By  the  twentieth  of  May  10  more  were  ready  to  open,  and  on 
May  22d  a  meeting  was  held  at  Seward  Park,  officially  opening  the  campaign. 
At  this  meeting  Borough  President  McAneny,  the  Rt.  Rev.  David  H.  Greer, 
the  Rt.  Rev.  Monsigneur  McMahon,  the  Rev.  Rabbi  Wise,  and  Commissioner  of 
Health  Lederle  spoke. 

On  May  31st  the  last  2  of  the  23  stations  were  opened;  with  the  original  4 
stations,  this  made  27. 

Realizing  that  the  problem  was  a  large  one,  and  that  every  energy  of  all  who 
were  interested  was  needed  to  do  the  necessary  work,  a  scheme  of  cooperation 
was  devised  to  prevent  unnecessary  duplication  of  work.  The  Association  of 
Infants'  Milk  Stations  was  organized  in  May.     Its  objects  were  briefly: 

1.  To  prevent  duplication  of  work  by  districting  the  city,  and  giving 

each  milk  station  a  distinct  area  for  its  activities. 

2.  To  establish  some  uniform  system  of  record  keeping,  so  that  the  work 

of  the  various  agencies  could  be  put  together  at  the  end  of  the 
season. 

3.  To  render  the  information  in  the  possession  of  one  group  available 

to  all. 

4.  To  conduct  a  publicity  campaign  in  the  interests  of  the  reduction  of 

infant  mortality. 
At  the  invitation  of  Commissioner  Lederle  a  meeting  was  held,  and  such  an 
association  was  formed  May  24   1911.    Eight  organizations,  maintaining  79  milk 
stations,  comprised  the  Association,  and  an  Executive  Committee,  composed  of  a 
representative  of  each,  was  organized,  as  follows: 

S.  Josephine  Baker,  M.D.,   Chief  Division  of 

Child  Hygiene Department  of  Health. 

Reuel  a.  Benson,  M.D Babies'  Dairies  Assn. 

Maria  L.  Daniels,  R.N N.  Y.  Diet  Kitchen  Assn. 

Arthur  R.  Green,  M.D Nathan  Strauss  Pasteurized  Milk  Labora- 
tories. 

Jane  E.  Hitchcock,  R.N Nurses'  Settlement. 

G.  N.  McCurdy Morningside  Milk  Dispensary. 

Paul  E.  Taylor,  Director N.  Y.  Milk  Committee. 

Arthur  E.  Wakeman Brooklyn  Children's  Aid  Society. 

Through  the  courtesy  of  Dr.  Baker  office  room,  with  use  of  a  stenographer 
and  clerk,  was  provided  at  the  headquarters  of  the  Division  of  Child  Hygiene. 
Dr.  H.  H.  Hart,  of  the  Child-Helping  Department  of  the  Russell  Sage  Foundation, 
provided  funds  for  the  salary  of  a  secretary.  Mr.  Charles  J.  Storey  was  appointed 
to  fill  this  position. 

By  a  committee  of  the  Association  the  city  was  districted,  thus  preventing 
two  nurses  from  visiting  the  same  family  and  wasting  time  and  effort.  Whenever 
possible,  a  baby  applying  at  a  station  living  outside  the  district  was  referred  to 
the  station  located  in  that  district,  but,  owing  to  the  price  of  the  milk  varying  in 
different  sets  of  stations,  this  was  not  always  possible  to  bring  about.  No  can- 
vassing was  done,  however,  outside  the  district  assigned  to  each  particular  station. 

Each  station  sent  in  a  weekly  report   in  detail  showing  its  enrolment  and 


EDUCATION  THROUGH  PRINTED  MATTER 


Exhibit  10 
Distributed  to  Thousands  of  Homes  by  Public  and  Private  Agencies 


THE  CAMPAIGN  IN  NEW  YORK  CITY  IN  1911  29 

all  details  of  importance,  which  were  tabulated  and  made  accessible  to  the 
other  organizations. 

The  27  stations  founded  by  the  Milk  Committee  were  situated  in  the  most 
congested  parts  of  the  city.  The  object  of  the  Committee's  campaign  was  to  make 
a  demonstration  of  the  value  of  milk  stations  in  reducing  infant  mortality;  to 
show  that  these  stations  should  be  situated  in  the  most  densely  populated  dis- 
tricts of  the  city;  and  that  the  ordinary  store  was  suited  for  a  milk  station. 

Many  of  the  situations  selected  were  far  from  ideal ;  vacant  stores  had  to  be 
utilized,  and  they  were  sometimes  not  situated  just  where  desired,  and,  as  was 
afterward  proved,  were  often  too  small.  The  Union  Settlement  in  East  One 
Hundred  and  Fourth  St.,  the  Vanderbilt  Clinic,  the  Wilson  Industrial  School, 
and  the  Alfred  Corning  Clark  House  gave  room  rent  free  for  the  stations. 

The  plan  of  campaign  was  as  follows:  Each  station  was  in  charge  of  a 
graduate  nurse  specially  chosen  for  her  knowledge  of  infant  hygiene,  for  her 
interest  in  the  problem,  and  her  willingness  to  give  herself,  as  well  as  her  time,  to 
the  work.  She  was  assisted  by  a  matron.  In  certain  districts  where  the  popu- 
lation was  almost  entirely  foreign,  and  where  English  was  spoken  and  understood 
as  rarely  as  in  Italy  or  Russia,  a  matron  was  selected,  when  possible,  who  was 
able  to  talk  the  language  of  the  district.  Where  two  or  more  languages  must  be 
spoken,  an  interpreter  was  provided  in  addition. 

Each  nurse  canvassed  her  district  from  house  to  house,  looking  for  babies, 
leaving  the  folder  of  the  station  with  the  mother,  and  offering  to  help  her  keep 
her  baby  well.  That  was  the  great  thing  the  stations  tried  to  teach — to  prevent 
sickness.  The  windows  of  each  station  were  adorned  with  placards  in  various 
languages  inviting  mothers  to  make  use  of  it.  The  outside  of  each  station  was 
painted  a  light,  bright  blue,  and  the  "Blue  Fronts"  became  a  regular  expression 
of  the  district,  being  incorporated  into  many  foreign  tongues. 

The  Milk  Committee  stations  tried  first  and  foremost  to  encourage  maternal 
nursing.  Mothers  were  told  how  necessary  it  was  and  how  it  would  save  the 
baby  many  of  the  dangers  of  the  hot  weather.  Not  only  were  they  urged  to 
nurse  their  babies,  but  they  were  taught  to  care  for  themselves  so  that  they  could 
nurse  them.  They  were  told  what  to  eat  and,  more  important,  what  not  to  eat 
and  drink.  When  breast-milk  seemed  to  be  failing,  they  were  provided  with  milk, 
and,  if  necessary,  nourishing  food,  to  try  to  increase  the  ability  to  nurse.  When 
nursing  was  impossible,  artificial  feeding  was  ordered  by  the  doctor  in  attendance 
at  the  station.  Each  baby  was  treated  as  an  individual,  and  the  food  ordered 
according  to  its  individual  needs. 

Let  us  trace  a  baby  through  its  whole  progress  at  the  station.  The  doctor 
was  in  attendance  at  definite  hours  twice  or  three  times  a  week.  If  a  new  baby 
was  brought  to  the  clinic,  it  was  seen  by  the  physician,  and  its  food  ordered  by 
him.  If  brought  in  at  another  time,  after  a  preliminary  talk  from  the  nurse 
in  which  the  whole  system  was  explained,  the  mother  was  asked  if  she  wanted 
to  enroll  her  baby.  If  so,  it  was  stripped  and  weighed  by  the  nurse  and  the 
weight  recorded  on  the  individual  chart.  The  nurse's  record  and  the  history 
card  were  then  filled  out,  and   the  nurse  ordered  a  temporary  feeding  for  the 


30  INFANT  MORTALITY  AND  MILK  STATIONS 

child,  according  to  instructions  very  carefully  prepared  by  the  supervising  phy- 
sician and  indorsed  by  the  Medical  Council.  If  the  baby  was  sick,  it  was 
sent  to  a  station  where  a  doctor  was  in  attendance  that  day,  or  the  station 
doctor  was  communicated  with  and  arranged  to  see  the  baby. 

Its  food  having  been  ordered,  the  mother  procured  her  supply  of  milk, 
bottles,  barley-flour,  etc.,  and  returned  to  her  home,  whither  the  nurse  speedily 
followed  her.  At  this  visit  she  was  taught  how  to  prepare  the  food;  and  in  her 
own  home,  where  existing  conditions  could  be  most  readily  appreciated,  she  was 
given  a  lesson  in  general  hygiene.  The  formulae  ordered  for  the  babies  were  of 
the  simplest  kind  possible.  Whole  milk  mixtures  were  used  almost  exclusively. 
She  was  then  told  to  bring  the  baby  back  to  the  station  on  the  next  clinic  day, 
and  to  come  every  morning  for  her  supply  of  milk.  She  was  also  urged,  at  the 
first  sign  of  illness,  however  slight,  to  report  at  once  to  the  station.  On  clinic 
days  every  baby  was  stripped,  weighed,  and  examined  by  the  station  physician, 
its  progress  discussed  with  the  mother,  any  necessary  changes  ordered,  and  the 
nurse  instructed  what  to  do.  Very  sick  babies  were  referred  to  hospitals  or  to 
private  physicians. 

If  the  mother  was  unable  to  buy  milk,  through  an  arrangement  with  the 
Charity  Organization  Society,  the  Association  for  Improving  the  Condition  of 
the  Poor,  and  the  United  Hebrew  Charities,  such  cases  were  immediately  reported 
to  them,  and  were  at  once  investigated.  In  almost  every  case — probably  in  every 
deserving  case — milk  relief  was  promptly  ordered  by  these  organizations. 

Regularity  in  attendance  at  clinics  was  demanded  from  the  mothers.  If  they 
refused  to  attend,  they  were  not  allowed  to  obtain  milk. 

It  was  hoped  that  as  many  as  75  babies  might  be  enrolled  at  each  station. 
By  the  fifteenth  of  July  many  of  the  stations  began  to  cry  for  help.  They  were 
so  overcrowded  they  could  not  properly  carry  on  their  work.  So  many  babies 
were  brought  to  the  clinics  that  they  could  not  all  get  in  and  blocked  the  side- 
walk. The  nurses  were  unable  to  do  the  follow-up  visiting  essential  to  a  suc- 
cessful campaign.  The  situation  was  carefully  considered,  and,  although  July 
is  not  a  favorable  month  to  try  to  raise  money,  funds  were  procured,  and  4 
new  stations  were  opened  to  relieve  those  most  urgently  in  need  of  assistance. 
The  full  list  was  as  follows: 

Old  Stations 306  E.  21st  St. 

73  Cannon  St. 
244  Mulberry  St. 
438  W.  48th  St. 

Opened  May  2d 248  E.  105th  St. 

722  E.  9th  St. 
1391  Avenue  A. 
229  E.  4th  St. 
114  Thompson  St. 
307  Tenth  Ave. 
35  Norfolk  St. 
174  Eldridge  St. 
325  E.  5th  St. 
239  W.  69th  St. 
56  Leroy  St. 


>4' 


EDUCATION  THROUGH  PRINTED  MATTER 


Exhibit   11 
Publicity  and  Information 


THE  CAMPAIGN  IN  NEW  YORK  CITY  IN  1911  31 

Opened  May  20th.  .  .  .37  Washington  St. 
326  E.  11th  St. 
316  E.  56th  St. 
512  Second  Ave. 
873  Second  Ave. 
1705  Second  Ave. 
235  E.  81st  St. 
315  E.  112th  St. 
3E.  115th  St. 
Vanderbilt  Clinic. 

Opened  May  31st  ....  165  Ludlow  St. 
200  E.  97th  St. 
Opened  July    8th  ....  331  Stanton  St.,  to  relieve  73  Cannon  St. 

Opened  July  10th 223  E.  75th  St.,  to  relieve  1391  Avenue  A. 

Opened  July  12th  ....  78  Ninth  Ave.,  a  new  station  where  the  summer  deaths  were  high. 
Opened  July  14th 1457  Madison  Ave.,  to  relieve  200  E.  97th  St. 

The  dates  given  above  are  those  on  which  milk  was  first  distributed.  The 
nurse  and  matron  had  been  at  work  in  the  district  for  several  days. 

Not  only  was  the  scope  of  work  increased  by  adding  four  new  stations,  but 
every  station  whose  enrolment  passed  the  100  mark  was  provided  with  an  extra 
nurse.  This  was  essential  if  the  purpose  of  the  station — instruction — was  to 
be  carried  out. 

In  August,  therefore,  31  stations  were  in  operation.  Doctors  were  on  duty, 
holding  clinics,  and  often  visiting  the  sick  babies  in  their  homes;  nurses  were 
daily  at  the  stations  and  visiting  in  the  homes,  watching,  advising,  encouraging, 
scolding,  teaching,  as  the  case  demanded.  As  the  nurse  went  about  from  house 
to  house,  from  family  to  family,  she  found  many  expectant  mothers.  Part  of 
the  campaign  was  to  get  in  touch  with  these  women  and  to  try  to  advise  and 
teach  them  so  that  they  might  pass  successfully  through  their  pregnancy  and  be 
in  physical  condition  to  nurse  their  babies.  It  was  soon  found  that  this  was  a 
large  undertaking,  and  in  August  a  special  nurse  was  delegated  to  take  charge 
of  this  work.  Her  salary  was  kindly  provided  by  Dr.  Hastings  H.  Hart,  of  the 
Russell  Sage  Foundation.  During  the  summer,  964  expectant  mothers  were 
under  observation. 

The  cooperation  existing  between  the  Milk  Committee  and  the  various 
charitable  organizations,  especially  those  already  mentioned,  was  of  the  closest 
kind.  Whenever  tired-out  mothers  were  found  whose  babies  were  doing  well 
enough  to  be  sent  away,  through  the  cordial  relations  existing  an  outing  was 
easily  arranged. 

The  Association  for  Improving  the  Condition  of  the  Poor  offered  to  receive  any 
baby  needing  hospital  treatment  at  Junior  Sea  Breeze  Hospital.  This  offer  was 
gladly  accepted,  and  during  the  summer  months  43  babies  were  admitted  there. 
At  discharge  or  death  a  report  of  the  case  was  made  to  the  Committee.  Discharged 
babies  were  immediately  referred  back  to  the  milk  station  from  which  they  came. 

Figures  showing  that  a  large  percentage  of  deaths  among  babies  occur  in  found- 
ling institutions,  the  Committeeoffered  the  services  of  its  milk  stations  to  the  New 
York  Foundling  Hospital  and  the  New  York  Infant  Asylum.  They  explained 
to  those  in  authority  at  these  institutions  the  purpose  of  the  stations.     The  offer 


32  INFANT  MORTALITY  AND  MILK  STATIONS 

was  gladly  accepted,  and  during  the  summer  110  babies  were  enrolled  from  these 
institutions.  The  fact  that  so  many  of  the  foster  mothers  lived  in  the  outlying 
boroughs  prevented  a  greater  number  from  being  able  to  make  use  of  the  stations. 

The  milk  which  was  used  during  the  summer  was  provided  by  the  New  York 
Dairy  Demonstration  Company.*  It  came  from  tuberculin-tested  herds  and  was 
of  the  highest  standard.  It  was  sold  for  seven  cents  a  quart.  The  contract 
for  this  milk  was  awarded  after  bids  had  been  asked  for  from  the  chief  milk- 
dealers  of  the  city.  A  constant  watch  was  kept  on  the  quality  of  this  milk. 
Bacterial  counts  were  made  daily  from  samples  taken  at  various  stations,  and 
control  bacterial  counts  were  made  frequently  by  the  Research  Laboratory  of 
the  Health  Department,  through  the  courtesy  of  Dr.  W.  H.  Park.  The  milk 
was  used  raw.  These  counts  were  compared  with  those  made  by  the  Health 
Department  of  the  milk  dispensed  at  their  stations  and  compared  favorably. 
The  table  showing  the  bacterial  counts  will  be  found  at  the  end  of  this  report. 

The  central  office  of  the  Committee  was  in  charge  of  the  Director,  Mr.  Paul 
E.  Taylor,  who  was  selected  by  the  committee  because  of  his  proved  executive 
and  constructive  ability  and  his  knowledge  of  the  problem  from  his  active  parti- 
cipation in  the  Philadelphia  campaign  of  1910.  He  was  associated  with  the 
Philadelphia  Bureau  of  Municipal  Research,  who  kindly  granted  him  leave  of 
absence  to  undertake  the  work  here. 

The  general  supervision  of  the  whole  work  was  in  the  hands  of  the  Director ; 
a  supervising  nurse  was  at  the  office  constantly;  station  nurses  were  instructed 
to  report  by  telephone  to  headquarters  every  difficulty  or  complication  which 
arose;  an  assistant  to  the  supervising  nurse  was  constantly  in  the  field,  visiting 
and  inspecting  the  stations;  and  a  special  assistant  was  appointed  during  the 
summer  to  keep  track  of  the  relief  cases. 

The  work  of  the  physicians  was  supervised  by  a  volunteer  supervising  phy- 
sician, who  visited  the  various  stations  as  often  as  possible,  and  especially  diffi- 
cult cases  when  asked,  and  was  general  adviser  on  all  strictly  medical  work. 
Much  of  the  supervising  work  was  done  by  the  assistant  supervising  physician. 

The  entire  scope  of  the  work  was  submitted  to  the  Medical  Council  in  consid- 
erable detail  and  was  indorsed  by  them. 

Work  of  the  Health  Department 

The  Department  of  Health  conducted  a  very  vigorous  campaign.     Fifteen 

stations  were  maintained  by  them  at  the  following  locations: 

Manhattan 108  Cherry  St.  Brooklyn 185  Bedford  Ave, 

31  Roosevelt  St.  296  Bushwick  Ave. 

209  Stanton  St.  128  Dupont  St. 

2287  First  Ave.  994  Flushing  Ave. 

207  Division  St.  698  Henry  St. 

651  Manhattan  Ave. 

Bronx 511  East  149th  St.  176  Nassau  St. 

129  Osborn  St. 
303  Williams  Ave. 

u-  u  *^Y^^  company  was  organized  by  the  New  York  Milk  Committee  to  demonstrate  that  a 
high-grade  milk  from  healthy  herds  can  be  produced  by  the  ordinary  farmer  with  ordinary 
equipment,  and  sold  at  a  price  usually  charged  for  bottled  milk  of  uncertain  quality.  (See  Fifth 
Annual  Report  of  New  York  Milk  Committee  for  details  of  this  experiment.) 


Jew  York  Milk  Committee*. 


)HP.\RTMEN'T  OF.HEALTH* 


i'athan  Strauss  Laboratories!  . . . , 


Tew  York  Diet  Kitchen* 


rx. 

(_N 

-li. 

<=> 

lL/1 

C3 

c_n 

<=> 

o 

s 

<=> 

8 

s 

g 

CO 

s 

C5 

■ 

^^ 

^^ 

- 

- 

H 

.ROOBO-YN'  Children's  Aid  SociETYf 


•GOD  Samaritan  DiSPENSARvt 


lENRY  Street  Settlement*. 


ENSON  Dairies! 


loRNiNGsiDE  Milk  Dispensary!.  •  •  • 


Home  modification  of  milk  taught. 
Milk  dispensed  modified. 


Exhibit  12 
Number  of  Babies  Registered  at  Milk  Stations  September,  1911 


THE  CAMPAIGN  IN  NEW  YORK  CITY  IN  1911  33 

The  same  general  policy  was  carried  out  in  the  stations  of  the  Health  Depart- 
ment as  in  those  of  the  New  York  Milk  Committee.  Individual  formulae  were 
ordered, — almost  always  whole  milk  formulae, — and  the  food  was  prepared  at  home 
under  supervision  of  the  nurse.  Careful  records  were  kept  and  the  cases  were 
followed  up.  The  work  of  the  summer  corps  was  coordinated  with  that  of  the 
milk  stations.  The  district  nurses  and  inspectors  received  lists  of  sick  babies 
from  the  stations  each  day,  and  visited  and  cared  for  the  sick  children  of  those 
unable  to  pay  a  physician.  The  department  cooperated  with  the  other  organi- 
zations, sending  their  inspectors  to  see  any  sick  child  in  the  care  of  a  milk  station 
on  request. 

The  "  Little  Mothers'  League"  continued  its  active  and  most  valuable  work 
in  teaching  the  future  mothers  of  the  city  how  to  care  for  the  little  brothers  and 
sisters  left  in  their  charge. 

The  efficient  cooperation  of  the  Health  Department  was  further  shown  by 
the  assignment  of  physicians  and  nurses  to  the  stations  of  the  Brooklyn  Children's 
Aid  Society  and  the  New  York  Diet  Kitchen  stations. 

The  milk  used  at  the  stations  was  the  Sheffield  Farms  Slawson-Decker 
pasteurized  milk,  and  was  sold  in  quart  and  pint  bottles,  unmodified,  for  seven 
cents  per  quart. 

Work  of  Other  Organizations 

The  New  York  Diet  Kitchen  maintained  8  stations  in  Manhattan  and  one 
in  the  Bronx,  as  follows: 

Manhattan 146  E.  7th  St. 

205  E.  66th  St. 

451  E.  86th  St. 

209  E.  103d  St. 

169  Mott  St. 

437  W.  41st  St. 

205  W.  62d  St. 

152  W.  100th  St. 
Bronx 583  Courtlandt  Ave. 

Daily  clinics  were  held  at  their  depots  in  charge  of  the  Health  Department 
physicians  and  nurses.  Formulae  were  ordered  according  to  each  baby's  indi- 
vidual needs,  and  mothers  were  taught  by  the  nurses  to  prepare  the  food  at  their 
homes. 

Certified  milk  in  bulk  was  dispensed,  the  daily  quantity  being  "dipped." 
It  was  sold  at  six  cents  a  quart.  The  same  records  and  system  were  employed 
as  at  the  Milk  Committee  and  Health  Department  stations. 

The  Nurses'  Settlement  station  was  continued  as  before.  Two  physicians 
were  in  charge  of  the  consultations,  and  the  settlement  nurses  did  the  home 
visiting.  Milk  was  tuberculin  tested  and  shipped  to  the  settlement  in  cans,  where 
it  was  bottled  and  sold  in  quart  and  pint  bottles  at  eight  cents  a  quart.  Modifi- 
cation was  carried  out  at  the  homes  according  to  individual  prescription  under 
the  supervision  of  visiting  nurses. 

All  the  above-mentioned  organizations  worked  along  similar  lines,  laying 
3 


34  INFANT  MORTALITY  AND  MILK  STATIONS 

special  emphasis  on  instruction,  in  the  belief  that  permanent  results  are  more 
likely  to  follow  teaching  a  mother  to  care  for  her  baby  and  its  food  herself,  than 
by  simply  giving  her  the  food  already  prepared.  The  campaign  was  also  parti- 
cipated in  by  other  organizations,  who  did  their  share  along  slightly  different 

lines. 

The  Nathan  Strauss  Pasteurized  Milk  laboratories  maintained  eight  stations : 

322  E.  59th  St.  348  E.  32d  St. 

303  E.  111th  St.  402  W.  37th  St. 

38  Macdougal  St.  Tompkins  Square  Park 

45  Monroe  St.  Educational    Alliance    Roof    Garden, 

197  East  Broadway 

From  these  stations  pasteurized  milk,  already  modified  to  set  formulae,  was 
dispensed  in  3- ,  6- ,  and  8-ounce  individual  feeding-bottles,  at  ten  cents  a  quart 
modified,  or  for  older  children  at  eight  cents  a  quart  unmodified.  There  was  no 
home  instruction  or  visiting  and  no  compulsory  medical  supervision. 

The  Babies'  Dairies  provided  tuberculin-tested  milk  in  individual  feeding- 
bottles,  modified  at  the  station  on  individual  prescription,  at  ten  cents  for  a 
day's  feeding.  Home  supervision  was  not  carried  out.  Medical  supervision  at 
the  station  was  provided.     The  stations  were  located  at — 

416  E.  65th  St. 
523  E.  78th  St. 
511  W.  41st  St. 
117  W.  63d  St.  (St.  Cyprian's,  colored) 

The  Good  Samaritan  Dispensary,  at  the  corner  of  Broome  and  Essex  Streets, 
continued  its  work,  dispensing  pasteurized  milk  modified  to  set  formulae.  The 
Morningside  Milk  Dispensary,  at  Morningside  Avenue  and  122d  Street,  dispensed 
pasteurized  milk,  modified  to  set  formulae,  in  individual  bottles  of  4,  6,  and 
8  ounces,  at  two  and  three  cents  the  bottle. 

In  Brooklyn  the  Children's  Aid  Society  maintained  14  stations.  Through 
the  active  cooperation  of  the  Health  Department  in  providing  the  physicians 
and  nurses,  follow-up  work  at  the  home  was  carried  on,  and  consultations  were 
held.  Considerable  attention  was  paid  to  the  educational  side.  Pasteurized 
milk,  modified  to  set  formulae,  was  sold  in  3-,  6-,  and  8-ounce  bottles,  at  one  and 
two  cents  a  bottle;  unmodified  milk  in  8-ounce  bottles  at  two  cents.  The 
stations  were  located  as  follows : 

105  Fleet  St.  190  Fourth  Ave. 
608  Fourth  Ave,  Pitkin,  cor.  of  Watkins  St. 
159  Wyona  St.  148  Jackson  Ave. 
817  Park  Ave.  165  Johnson  Ave. 

106  S.  3d  St.  85  Java  St. 
27  Columbia  Place  201  Hoyt  St. 
146  Union  St.  15  Garnet  St. 

These  stations  were  open  from  June  15th  to  September  15th. 

The  various  dispensaries  and  hospitals  continued  their  follow-up  work 
through  visiting  nurses.  Bellevue  Hospital,  Presbyterian,  Roosevelt,  St.  Luke's, 
Mt.  Sinai,  The  Babies',  University  and  Bellevue  Medical  School  Dispensary,   j 


u 
a 

■r-l        f 

a  3 

^   > 


Exhibit  14 

The  Committee  Provided  the  Board  of  Estimate  and  Apportionment  With  the  Facts- 

The  Number  of  Municipal  Stations  was  Increased  From  Fifteen  to  Fifty-five 


THE  CAMPAIGN  IN  NEW  YORK  CITY  IN  1191  35 

Vanderbilt  Clinic,  and  many  others  have  visiting  nurses  who  instruct  mothers 
in  the  care  of  their  babies,  and  all  are  factors  in  the  campaign.  There  was, 
however,  no  particular  change  from  previous  years  in  their  methods.  The  same 
applies  to  the  St.  John's  Guild  and  Junior  Sea  Breeze,  except  as  already  noted  in 
regard  to  cooperation  with  the  milk  stations. 

Cooperation  was  earnestly  sought  from  all  the  special  agencies.  The  New 
York  Milk  Committee  sent  out  an  information  card,  giving  the  list  of  all  milk 
stations  and  information  regarding  kind  of  milk,  method  of  preparation,  cost, 
etc.  This  card  was  sent  to  hospitals,  dispensaries,  social  workers,  nurses'  settle- 
ments, and  many  physicians. 

Police  Commissioner  Waldo  distributed  lists  of  the  milk  stations,  provided 
by  the  Milk  Committee  in  size  suitable  for  carrying  in  the  pocket,  to  all  patrol- 
men of  the  police  force,  and  issued  instructions  to  give  the  address  of  the  nearest 
station  to  any  mother  with  a  sick  baby  seen  in  the  parks  or  on  the  recreation 
piers.  The  cooperation  of  the  press  was  active.  Articles  appeared  frequently 
in  many  newspapers  in  New  York  and  throughout  the  country.  Editorial  help 
was  also  frequently  given. 

Toward  the  latter  part  of  the  summer  the  committee  prepared  to  back  up 
the  Commissioner  of  Health  in  his  request  for  funds  to  maintain  75  milk  stations 
in  New  York  in  1912.  All  summer  special  statistics  had  been  compiled  through 
the  courtesy  of  Dr.  Guilfoy,  Registrar  of  the  Health  Department,  who  allowed 
access  to  the  records.  These  statistics  were  put  together  in  as  striking  a  manner 
as  possible,  with  charts  and  tables.  A  detailed  study  of  the  location  of  the  high 
mortality  centers  was  made  by  a  member  of  the  Executive  Committee,  and  the 
results  of  this  study  were  embodied  in  a  report  which  was  delivered  to  each  member 
of  the  Board  of  Estimate  and  Apportionment  before  the  hearings. 

The  Committee  was  represented  at  the  public  hearings ;  only  one  protesting 
voice  was  raised  there  against  the  appropriation,  and  in  this  case  it  was  evident 
that  the  protester  did  not  understand  what  the  money  was  to  be  used  for.  The 
Board  finally  appropriated  money  to  maintain  55  stations,  which,  although  16 
less  than  the  number  urged  by  the  Milk  Committee,  was  a  very  great  advance 
over  the  15  provided  for  the  previous  year;  and  there  is  hope  that  if  these  are 
efficiently  carried  on  in  1912,  the  full  number  will  be  provided  for  in  1913. 


CHAPTER  IV 

Results  of  the  Campaign  in  New  York  City 

In  the  pages  that  follow  an  honest  attempt  is  made  to  discuss  fairly  the  facts 
shown  by  vital  statistics.  As  already  mentioned,  the  factors  in  infant  mortality 
are  many  and  complicated,  and  at  the  present  moment  many  statistics  are  still 
unavailable.     Only  the  most  obvious  facts  can  be  more  than  briefly  touched  upon. 

In  studying  the  mortality  among  infants  in  this  country  we  are  sadly  handi- 
capped by  lax  registration  ordinances — lax  themselves  or  laxly  enforced.  The 
recognized  method  of  rating  yearly  infant  mortality  is  to  record  the  number  of 
deaths  in  infants  under  one  year  of  age  per  1000  births  during  the  same  year. 
In  New  York  the  registration  of  births  has  been  incomplete  up  to  the  last  few 
years;  therefore  comparisons  of  infant  mortality  rates  (deaths  per  1000  births) 
cannot  be  made  between  widely  separated  periods.  The  years  1901  and  1911,  for 
instance,  cannot  be  compared.  The  greater  the  number  of  unreported  births, 
the  higher  will  be  the  rate,  of  course.  A  glance  at  Table  6  will  show  that  in  1901 
the  rate  was  191.5,  while  in  1911  it  was  111.6.  Nobody  believes  this  really  hap- 
pened. So  inaccurate  is  this  method  that  the  Census  Bureau  has  only  in  1910 
begun  to  record  these  figures,  and  then  (Bulletin  No.  109)  only  for  35  large  cities. 
Only  5  of  the  10  largest  cities  in  the  country  have  sufficiently  complete  registra- 
tion of  births  to  be  includea.  Chicago  admits  that  not  more  than  one-third  of 
the  births  are  registered,  but  steps  are  being  taken  to  remedy  this  state  of  affairs. 

Another  method  of  rating  infant  mortality  is  on  the  estimated  population 
under  one  year,  based  on  the  percentage  at  that  age  according  to  the  last  United 
States  Census,  and  assuming  this  percentage  to  remain  constant.  The  results 
are,  of  course,  only  approximate. 

Again,  the  number  of  deaths  under  one  year  of  age  in  proportion  to  all  deaths 
is  an  approximate  method  of  estimate. 

Tables  6,  7,  8,  and  9  show  in  some  detail  the  infant  mortality  by  months  and 
groups  of  months,  in  the  city  of  New  York  as  a  whole,  the  boroughs  of  Man- 
hattan and  Brooklyn,  and  the  "  Rest  of  the  City"  (comprising  Bronx,  Queens,  and 
Richmond),  for  the  years  1901  to  1911  inclusive,  with  five- and  ten-year  averages- 
It  also  shows  the  relation  to  total  mortality  and  to  births. 

It  will  be  noted  that  there  is  a  steady  tendency  to  increase  from  1901  through 
1907,  with  the  exception  of  1903.  The  year  1903  shows  the  lowest  gross  total 
mortality  of  any  year  in  the  decade  1901-10. 

Again  it  will  be  noted  that  in  1908  there  was  a  sharp  fall  of  1206  deaths  in 
New  York  city  from  the  record  of  1907;  a  further  decrease  of  255  in  1909;  a 
rise  of  239  in  1910;  followed  in  1911  by  a  fall  of  1198.  In  other  words,  in  1908 
there  was  a  sharp  fall,  a  small  change  in  1909  and  1910,  followed  by  another  sharp 
fall  in  1911. 

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Exhibit  15 

Infant  Deaths  Occurring  in  New  York  City  by  Weeks 

(1909, 1910, 1911) 


RESULTS  OF  THE  CAMPAIGN  IN  NEW  YORK  CITY         41 


As  already  mentioned,  in  1908  there  was  a  very  great  increase  in  activity  in 
the  campaign  in  New  York.  That  was  the  year  of  the  formation  of  the  Division 
of  Child  Hygiene  in  the  Health  Department;  the  cooperation  of  the  Health 
Department  with  the  Children's  Aid  Society;  the  effort  to  bring  about  general 
cooperation,  as  shown  by  the  first  conference  on  the  summer  care  of  babies;  the 
opening  of  seven  milk  depots  by  the  New  York  Milk  Committee;  in  other  words, 
a  great  extension  of  the  campaign  and  the  coming  to  the  front  of  educational 
prevention. 

The  year  1911  was  another  one  of  great  extension  in  the  work,  especially 
along  educational  lines. 

It  must  be  remembered  that  the  special  efforts  were  confined  largely  to  the 
summer  months ;  also  it  must  be  remembered  that  the  problem  is  very  different 
in  different  boroughs,  owing  to  their  different  physical  characteristics.  The 
following  tables  illustrate  the  changes  that  have  occurred  since  1908: 

TABLE  10.— MORTALITY  UNDER  ONE  YEAR  IN  NEW  YORK  CITY  OCCURRING 
DURING  THREE  SUMMER  MONTHS 


1908 

1909 

1910 

1911 

Actual 

Percentage  of  year  .  . 

5739 
35.3 

5154 
32.2 

5574 
34.3 

4593 
30.5 

It  will  be  noticed,  from  Table  10,  that  while  the  total  year's  mortality  in 
1908  was  low,  the  summer  mortality  was  quite  high — higher  than  either  1909  or 
1910—35.35  per  cent,  in  1908,  as  against  32.26  per  cent,  in  1909,  and  34.37  per 
cent,  in  1910.     It  was,  however,  below  previous  years,  except  1903. 

In  1911  the  summer  mortality  was  low,  being  only  30.58  per  cent,  of  the 
year's  total.     Table  11  shows  the  difference  between  these  years  and  1911. 


TABLE  11.— DIFFERENCE  BETWEEN  MORTALITY  UNDER  ONE  YEAR  IN  THREE 
SUMMER  MONTHS  OF  1911  AND  CERTAIN  OTHER  YEARS 

From  1908 

From  1909 

From  1910 

Actual 

—1146 
—19.9 

—561 
—10.8 

—981 

Percentage 

—17.6 

The  summer  mortality  in  1911,  compared  with  the  three  previous  years  in 
the  different  boroughs,  as  shown  in  Tables  12  and  13,  is  worth  noticing. 

TABLE  12.— MORTALITY  UNDER  ONE  YEAR  DURING  THREE  SUMMER  MONTHS 
IN   DIFFERENT  SECTIONS  OF   NEW  YORK    CITY 


1908 

1909 

1910 

1911 

Manhattan 

Brooklyn  

Actual 

Percentage  of  year 
Actual 

3043 
33.63 
1835 
36.6 
861 
37.9 

2640 
29.61 
1733 
35.2 
781 
36.5 

2952 
32.96 
1768 
34.9 
854 
38.7 

2294 
28.00 

1499 

Rest  of  City  . . 

Percentage  of  year 

Actual 

Percentage  of  year 

32.3 

800 
34.8 

42 


INFANT  MORTALITY  AND  MILK  STATIONS 


T\BLE  13 —DIFFERENCE  BETWEEN  MORTALITY  UNDER  ONE  YEAR  IN  THREE 
■  SUMMER  MONTHS  OF  1911  AND  CERTAIN  OTHER  YEARS 


From  1908 

From  1909 

From  1910 

Manhattan 

Actual 

—749 

-34.6 

—336 

—18.3 

—61 

—7 

—346 
—13.1 

—234 
—13.5 

+  19 

+3.4 

—658 

—33.3 

Actual 

—269 

—37.8 

Rp^T  OR  CtTV 

Actual 

—54 

—6.3 

It  will  be  seen  that  while  there  was  a  very  great  actual  and  percentage 
reduction  in  1911  from  the  figures  in  1908  to  1910  in  both  Manhattan  and  Brook- 
lyn, in  the  Rest  of  the  City  this  was  not  so  marked.  There  was  an  actual  increase 
over  1909  figures. 

The  proportion  of  deaths  occurring  in  the  third  quarter  of  the  year  was  very 
low.  Table  14  shows  the  distribution  of  the  mortality  by  trimesters  for  the  years 
1901-1911,  with  five-  and  ten-year  averages  for  the  boroughs  of  Manhattan, 
Brooklyn,  and  the  "Rest  of  the  City." 

It  will  be  noted  that  in  Manhattan  only  28  per  cent,  of  the  year's  mortality 
occurred  during  the  third  quarter,  while  the  ten-year  average  is  33.8  per  cent., 
and  the  five-year  average,  1906-1910,  is  32.8  per  cent.  In  no  single  year  was 
so  low  a  figure  reached,  and  in  only  one,  1909,  did  it  fall  below  30  per  cent.  This 
occurred  in  connection  with  a  very  low  total  mortality  for  the  whole  year. 

The  figure  for  Brooklyn  ''s  32.4  per  cent.,  as  against  the  ten-year  average  of 
38  per  cent.     It  is  also  the  lowest  of  any  single  year  by  2.5  per  cent. 

The  "Rest  of  the  City"  shows  36.4  per  cent.,  the  ten-year  average  being 
41.9  per  cent.  But  in  1909  the  proportion  was  36.5  per  cent.  The  lower  figure 
and  the  proportionately  greater  reduction  seem  to  make  the  inference  fair  that 
the  more  extensive  and  active  campaign  in  Manhattan  was  responsible,  in  part, 
at  any  rate.  i| 

The  New  York  Milk  Committee  opened  its  stations  in  1911  in  the  latter 
part  of  May.  The  campaign  did  not  really  come  into  full  swing  until  June.  So 
far  as  the  Milk  Committee  was  concerned,  it  ceased  its  work  on  the  first  day  of 
November,  when  the  Health  Department  took  over  22  of  the  31  stations  which  it 
had  maintained  during  the  summer.  In  order  to  estimate  the  effect  of  the 
campaign  during  these  five  months,  tabulations  have  been  made  of  the  deaths 
in  the  various  parts  of  the  city  for  a  number  of  years  and  the  births  occurring 
during  corresponding  twelve-month  periods  ending  October  1st. 

In  the  summer  of  1911  there  were  in  Manhattan  57  milk  stations;  in  Brook- 
lyn, 23;  and  in  the  Bronx,  1.  These  tabulations  have  been  made  for  Manhattan, 
Brooklyn,  and  the  "Rest  of  the  City."  This  last  area  has  been  taken  because 
in  all  three  boroughs  there  was  practically  no  milk  station  work.  The  regular 
summer  corps  work  of  the  Health  Department  was  carried  on  as  heretofore. 
Table  15  shows  the  results. 


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INFANT  MORTALITY  AND  MILK  STATIONS 


TABLE    15  —MORTALITY    UNDER    ONE  YEAR   DURING   MONTHS  JUNE  1ST  TO 
NOVEMBER   1ST  IN  VARIOUS  SECTIONS  OF  GREATER  NEW  YORK 


1908 

1909 

1910 

1911 

Manhattan: 

644 

1185 

1059 

799 

677 

630 
810 
1071 
759 
733 

723 

1126 

1004 

822 

720 

572 

Tijlv        

764 

859 

671 

627 

Total    

4364 

4003 

4395 

3493 

Brooklyn: 

379 
769 
592 
474 
371 

341 
682 
562 
489 
385 

426 
782 
543 
443 
430 

328 

Julv   

506 

545 

448 

415 

Total  

2585 

2459 

2624 

2242 

"Rest  of  City": 

147 
363 
299 
199 

184 

131 
267 
306 
208 
185 

148 
345 
293 
216 
194 

134 

Tulv 

260 

August 

327 

September 

213 

October 

147 

Total 

1192 

1097 

1196 

1081 

It  will  be  noted  in  Table  15  that  the  deaths  under  one  year  in  1908  and  1910 
in  all  three  areas  were  nearly  the  same.  In  1909  the  total  was  lower  than  in  the 
years  preceding  and  following.  The  year  1911  shows  a  very  great  drop  in  Man- 
hattan and  a  very  distinct  drop  in  Brooklyn,  and  almost  no  drop  in  the  Rest  of 
the  City  compared  with  1909.  Table  16  shows  the  differences  in  actual  numbers 
and  in  percentages.  From  the  gross  figures  it  appears  that  the  Rest  of  the  City 
did  not  do  nearly  so  well  as  Manhattan  and  Brooklyn. 


TABLE  16.— DIFFERENCE  BETWEEN  MORTALITY  UNDER  ONE  YEAR  IN  MONTHS 
JUNE  1ST  TO  NOVEMBER  1ST,  1911,  AND  CERTAIN  OTHER  YEARS  IN  DIFFER- 
ENT SECTIONS  OF  GREATER  NEW  YORK 


From  1908 


From  1909 

From  1910 

—510 

—12.7 

—902 
—20.5 

—217 
—8.8 

—382 
—14.5 

—16 
—1.4 

—115 
—9.6 

Manhattan: 

Actual .  .  . . 

Percentage 
Brooklyn: 

Actual.  .  .  . 

Percentage 
"Rest  of  City": 

Actual .  .  .  . 

Percentage 


—871 
—19.9 

—343 
—13.2 

—HI 
—9.3 


Table  17  shows  the  actual  and  percentage  changes  in  the  gross  infant  mor- 


RESULTS  OF  THE  CAMPAIGN  IN  NEW  YORK  CITY      45 

tality  for  these  three  areas  for  each  of  the  years  1909,  1910,  and  1911,  compared 
with  previous  years  back  to  1908. 

TABLE  17.— DIFFERENCE  IN  MORTALITY  UNDER  ONE  YEAR  DURING  MONTHS 
TUNE  1ST  TO  NOVEMBER  1ST  BETWEEN  CERTAIN  YEARS  AND  YEARS  PRE- 
CEDING 

1909  as  Compared  With  1908 

Actual  Difference  Percentage  Difference 

Manhattan — 361  — 8.27 

Brooklyn   — 126  — 4.87 

"Rest  of  City" —  95  — 7.97 

1910  as  Compared  With  1908  and  1909 

Actual  Difference  Percentage  Difference 

1908  1909  1908  1909 

Manhattan +31  +392  +0.71  +9.79 

Brooexyn +39  +165  +1.50  +6.71 

"Rest  OF  City" +  4  +99  +0.33  +9.02 

1911  as  Compared  With  1908,  1909,  and  1910 

Actual  Difference  Percentage  Difference 

1908  1909  1910  1908  1909  1910 

Manhattan —871        —510        —902  —19.9        —12.7        —20.5 

Brooklyn —343        —217        —383  —13.2        —8.8        —14.5 

"Rest  OF  City"  .   —Ill        —  16        —115  —  9.3        —  1.4        —  9.6 

Table  18  compares  the  percentage  difference  in  actual  deaths  under  one  year 
during  this  period  for  each  area  in  the  years  1909,  1910,  1911,  and  with  the  year 
immediately  preceding.  It  will  be  seen  that  in  Manhattan  and  Brooklyn  the 
percentage  decrease  in  deaths  during  these  months  in  1911  was  greater  than  in 
either  1910  or  1909,  while  for  the  rest  of  the  city  the  change  is  very  much  less. 

TABLE    18.— PERCENTAGE   DIFFERENCE   BETWEEN   THE   MORTALITY   UNDER 

ONE  YEAR  DURING  MONTHS  JUNE  1ST  TO  NOVEMBER  1ST  IN  1909,  1910,  AND 

1911,  AND  THE  YEAR  IMMEDIATELY  PRECEDING 

1909  1910  1911 

Manhattan —8.27%  +9.79%  —20.5% 

Brooklyn —4.87  +6.71  —14.5 

"Rest  OF  City" —7.97  +9.02  —9.6 

These  gross  figures,  as  given  above,  make  no  allowance  for  the  increase  in 
population.  Taking  the  census  figures  of  1910  as  a  basis,  the  percentage  increase 
in  population  for  1900-1910  for  the  various  areas  is: 

Manhattan,  ten  years 26.020 

Yearly  average, 2.602 

Brooklyn,  ten  years 40.100 

Yearly  average 4.010 

"  Rest  of  City,"  ten  years 90.380 

Yearly  average 9.038 

If  we  apply  this  increase  to  the  number  of  deaths  occurring  in  1909,  the  low 
year  of  the  five  preceding  1911,  and  compare  with  these  figures  the  actual 
deaths  which  did  occur  in  these  years  during  this  same  period,  we  find  some  in- 
teresting points,  as  shown  by  the  following  table: 


46  INFANT  MORTALITY  AND  MILK  STATIONS 

T\BLE  19— MORTALITY  UNDER  ONE  YEAR.  WHICH  SHOL-LD  HAX'E  OCCURRED 

'during  the  months  JUNE  TO  NO\TMBER.   1910  AND  1911,  ON  BASIS  OF 

1909  FIGURES.  -\LLO\VLNG  FOR  INCREASE  IN  POPLXATION 

1910  1911 

Maxhattax ^10"        ^211 

Brooklyx -^-'         26:>6 

" Rest  of  City" 1196        1295 

The  actual  and  percentage  differences  from  these  estimated  mortalities  are: 

AcTV.u.  Percentages 

1910  1911  1910  1911 

Maxhattax -f288  —718  +7.0  —17.0 

Brooklyx -f  67  — 414  -f  2.6  — 15.5 

••RESTOFCmr" -     0  —214  -fO.O  —16.5 

There  has  been  in  the  "Rest  of  the  City"  a  steady  tendency  downward 
during  the  l^t  three  years.  In  1910,  when  Manhattan  and  Brooklyn  were  in 
excess  of  the  estimated  mortality',  the  "Rest  of  the  City"  maintained  the  same 
proportion.    In  1911  it  fell  more  than  Brooklyn,  and  almost  as  much  as  Manhattan. 

It  is  possible  that  the  influence  of  the  campaign  in  New  York  city  may  have 
had  something  to  do  with  this  result.  Conditions  in  these  outlying  boroughs  are 
very  different  from  Manhattan  and  Brooklyn. 

If,  now,  we  look  at  the  infant  mortalitj'  rates  for  these  years,  we  find  that, 
based  on  the  total  births  for  the  year,  the  proportion  of  infant  deaths  in  the 
months  of  June  to  November  Ist  was: 

TABLE  20.— INFANT  MORT.ALITY  R-\TE  FOR  MONTHS  TUNE  TO  NO\^MBER  FOR 

DIFFERENT  SECTIONS  OF  GREATER  NEW  YORK 

19-08  1909  1910  1911 

Maxhattax 65.2  62.9  66.2  52.5 

Brooklyx 61.6  59.2  61.4  49.0 

"Rest  OF  City" 65.9  61.3  59,7  48.5 

Table  21  shows  the  actual  and  percentage  difference  in  these  rates  compared 
\Nnth  the  years  preceding,  during  the  period  discussed : 

TABLE  21.— DIFFERENCE   IN   INFANT   MORT.\LITY   R.\TE  FOR  MONTHS  JUNE 

TO  NOVEMBER.   BETWEEN   1909.    1910,  AND    1911,   AND  YEARS  PRECEDING, 

FOR  DIFFERENT  SECTIONS  OF  GREATER  NEW  YORK 

19W  as  Compared  Wilh  1908 

Actual  Pee  Cekt. 

Maxhattax — 2.3  — 3.52 

Brooklyx — 2.4  — 3.89 

"  Rest  of  City  " — 4.6  — 6.98 

1910  as  Compared  With  1908  and  1909 

AcTUAi  Per  Cent. 

1908  1909  1908  1909 

Maxhattax -rl.O  -3.3  -1.53  +5.24 

Brooklyx —0.2  -2.2  —0.32  +3.71 

"Rest  OF  City" —6.2  —1.6  —8.16  —2.6 

1911  as  Compared  With  1908,  1909,  and  1910 

Actual  Per  Cekt. 

1908  1909  1910  1908  1909  1910 

Maxhattax — 12.7    —10.4    —13.7        —19.4    —16.5    —20.7 

Brooklyx —12.6    —10.2     —12.4        —20.4    —17.2     —20.1 

Rest  OF  City" —17.4    —12.8    —11.2        —26.4    —20.8     —18.7 


I         ;'  '.  1 


I       / 


^Vl 


AM/ 


y  \ 


^^  h  /\ 


ApJf 


f«g 


Exhibit  16 

Deaths  of  Infants,  1909,  1910,  1911,  by  Weeks 

Upper  Chart — Manhattan;    Lower  Chart — Brooklyn 


RESULTS  OF  THE  CAMPAIGN  IN  NEW  YORK  CITY        47 

Comparing  the  percentage  change  in  the  infant  mortality  rates  in  consecutive 
years  we  find: 

TABLE  22 

1909  1910  1911 

Manhattan —3.5  +5.2  —20.0 

Brooklyn —3.8  +3.7  —20.1 

"Rest  OF  City" —6.9  —2.6  —18.7 

The  mortahty  rate  of  the  "Rest  of  the  City"  fell  in  1909  much  more  than 
that  of  Manhattan  and  Brooklyn.  In  1910  it  fell,  while  that  of  the  other  two 
boroughs  rose.  In  1911,  in  Manhattan  and  Brooklyn,  the  mortality  fell  more 
than  in  the  "Rest  of  the  City." 

The  tables  given  above  would  seem  to  show  that — 

(i)     In  the  city  of  New   York  during  the  summer  and  early  fall  of  1911 

there  was  a  very  great  diminution  in  infant  mortality. 
(2)     That  the  diminution  is  demonstrable  both  in  the  gross  infant  mortality 

and  in  the  infant  mortality  rate. 
(j)     That  the  diminution  is  slightly  but  distinctly  more  marked  in  the  bor- 
oughs of  Manhattan  and  Brooklyn,  where  the  greatest  efforts  were  put 
forth,  than  in  the  "Rest  of  the  City. " 
It  is  a  well-known  fact  that  infant  mortality  tends  to  vary  from  year  to  year 
in  given  localities.     This  is  usually  explained  on  the  ground  of  varying  weather 
conditions.     Summers  of  intense  heat  and  scant  rainfall   have   usually  been 
followed  by  a  high  infant  mortality.     It  remains  now  to  investigate  weather 
conditions  which  have  existed  in  New  York  during  certain  years,  and  to  see  how 
they  compare  with  the  mortality  rates. 

Table  23  shows  the  number  of  days  on  which  the  maximum  temperature  and 
mean  temperature  reached  or  passed  certain  figures. 

TABLE   23.*— NUMBER   OF   DAYS   MAXIMUM   AND   MEAN   TEMPERATURES   IN 
NEW  YORK  REACHED  CERTAIN  FIGURES 

Maximum  Temperature  was  Mean  Temperature  was 

95°  or  +  90°  or  +         85°  or  +  85°  or  +  80°  or  + 

June 

1901 2  5  10  1  5 

1903 0  0  0  0  0 

1908 0  18  0  4 

1909 0  4  9  0  6 

1910 0  2  6  0  3 

1911 0  0  2  0  0 

July 

1901 2  9  19  2  12 

1903 1  6  12  0  5 

1908 2  7  21  2  18 

1909 0  2  10  0  3 

1910 0  4  19  0  10 

1911 6  10  18  6  9 

August 

1901 0  17  0  2 

1903 0  0  3  0  0 

1908 0  4  10  3  6 

1909 0     '  4  7  0  2 

1910 0  0  1  0  0 

1911 0  5  12  0  3 

*  New  York  Meteorological  Observatory  Reports. 


48  INFANT  MORTALITY  AND  MILK  STATIONS 

Maximum  Temperature  was  Mean  Temperature  was 

95°  or  4-  90°  or  +         85°  or  +  85°  or  +  80°  or  + 
September 

1901               0  0                  4  0  0 

1903 0  0                  3  0  0 

1908 0  0                  0  0  0 

1909             0  0                  0  0  0 

1910 0  12  0  1 

1911 0  0                  3  0  0 

June-September 

1901           4  15  40  3  19 

1903 1  6  18  0  5 

1908       2  12  39  5  28 

1909         0  10  26  0  11 

1910 0  7  28  0  14 

1911 6  15  35  6  12 

The  years  1901  and  1903  are  included  in  the  above  table,  because  the  latter 
showed  the  lowest  year's  mortality  on  record  since  1901.  The  annual  meteorologic 
summary  for  1911,  issued  by  the  Weather  Bureau  (New  York),  contains  the 

following  statement:    "July,  period hot  weather  exceeded  only  by  that  of 

July,  1901,  in  duration  and  intensity,  prevailed  during  the  first  thirteen  days  of 
the  month."  The  highest  temperature  was  only  one  degree  below  the  highest 
ever  recorded  at  the  station,  and  for  thirteen  days  the  average  temperature  was 
81°.     These  records  were  taken  400  feet  above  the  street. 

Not  only  was  the  number  of  days  when  the  temperature  reached  the  high 
point  greater  in  1911  than  in  these  other  years,  but  the  duration  of  the  heat  was 
greater,  as  will  be  seen  in  Table  24. 

TABLE  24.*— NUMBER  OF  HOURS  TEMPERATURE  WAS  AT  OR  ABOVE  CERTAIN    ^ 

FIGURES 

Temperature  was 
95°  or  +        90°  or  +         85°  or  + 

June 

1901 3  23  66 

1903 0  0  0 

1908 0  5  38 

1909 0  14  65 

1910 0  5  34 

1911 0  0  10 

July 

1901 10  40  134 

1903 1  26  80 

1908 3  33  149 

1909 0  6  41 

1910 0  20  100 

1911 25  67  151 

August 

1901 0  3  35 

1903 0  0  11 

|908 0  24  76 

909 0  10  34 

1910 0  0  5 

1911 0      ,  15  59 

September 

1901 0  0  12 

1903 0  0  11 

1908 0  0  0 

1909 0  0  0 

1911 0  0  8 

*  New  York  Meteorological  Observatory  Reports. 


RESULTS  OF  THE  CAMPAIGN  IN  NEW  YORK  CITY        49 


June-September 

1901 

1903 

1908 

1909 

1910 

1911 


Temperature  was 

"or  + 

90°  or  + 

85"  or  - 

13 

86 

247 

1 

26 

102 

3 

62 

263 

0 

30 

140 

0 

30 

153 

25 

82 

228 

This  table  shows  a  very  much  greater  duration  of  heat  than  in  any  other  of 
the  years  tabulated,  especially  in  regard  to  temperatures  of  90°  or  over.  In  1908 
a  temperature  of  85°  or  over  was  maintained  longer  than  in  1911,  but  in  1909 
and  1910  weather  conditions  were  much  less  severe.  The  years  1901  and  1903 
will  be  discussed  later.  The  mean  temperature  for  the  month  taken  alone 
is  deceptive  in  making  comparisons,  a  long  period  of  hot  weather  being  often 
balanced  by  a  long  cool  period,  or  short  hot  and  cool  periods  following  one  another. 
The  following  table  (Table  25),  taken  in  conjunction  with  Table  24,  shows  the 
records  for  the  four  months  of  June,  July,  August,  and  September,  and  the 
average  monthly  mean  over  a  period  of  forty-two  years : 

TABLE  25— MEAN  MONTHLY  TEMPERATURES  AND  INFANT  MORTALITY  RATES, 

JUNE-SEPTEMBER* 


Average  Mean  Temperature  for  Month 
FOR  Forty-two  Years 


June 70.3 

July 75.3 

August 73.3 

September 67.1 

Infant  mortality 

Rate 


70.5 
77.7 
74.9 
68.1 


7311 
(90.5) 


1903 


64.2 
74.6 
69.0 
67.0 


6210 
(65.5) 


1908 


72.9 
79.8 

75.7 
68.3 


6909 
54.4 


1909 


72.1 
73.5 
72.2 
66.8 


6256 
50.8 


1910 


68.7 
77.2 
72.0 
69.4 


6871 
53.2 


1911 


69.8 
77.5 
72.8 
67.6 


5627 
41.8 


Table  25  shows  that  the  mean  monthly  temperature  in  1908  for  all  four 
months  was  distinctly  above  the  average  for  the  forty-two  years.  In  this  year 
the  summer  mortality  was  high,  being  54.4.  In  1909  June  alone  was  above  the 
average  mean,  July  and  August  being  considerably  below,  and  September  slightly 
below;  the  infant  mortality  was  low,  the  rate  being  50.8.  The  records  for  1910 
and  1911  were  very  similar.  In  June  both  were  below  the  average  mean,  espe- 
cially 1910.  July  was  nearly  two  degrees  above  the  mean  in  both  years;  August 
was  below  in  both,  1911  being  the  higher  of  the  two.  September  shows  con- 
siderable excess  in  1910  and  a  slight  excess  in  1911,  In  the  death-rates  for  the 
two  years  there  is  a  difference  of  1.4  in  favor  of  1911.  So  far  as  temperature  was 
concerned,  it  would  seem  that  1911  was  a  bad  year. 

The  year  1903  was  the  remarkable  one  of  the  decade  as  to  low  infant  mortal- 
ity, both  for  the  year  and  for  the  four  months  June,  July,  August,  and  September. 
Its  death-rate,  based  upon  births  for  the  entire  year  and  for  the  summer  months, 
was  also  much  below  the  years  preceding  and  following;  in  fact,  the  yearly  rate 
was  not  equaled  again  until  1907,  when  there  was  a  very  great  increase  in  the  re- 
ported births.  In  1903  there  can  be  no  question  as  to  the  remarkable  weather 
4  *  New  York  Meteorological  Observatory  Reports. 


50  INFANT  MORTALITY  AND  MILK  STATIONS 

conditions  that  prevailed.  June  was  over  6°  below  the  mean;  July,  0.7°  below; 
August,  over  4°  below;  and  September,  about  the  average.  On  only  one  day  of 
the  four  months  did  the  temperature  reach  95°  or  over,  and  it  remained  there  for 
only  one  hour.  For  only  nine  hours  did  it  reach  90°  or  over,  and  for  only  102 
hours  was  it  S5°+.  The  mean  temperature  never  reached  85°  and  was  only  80° 
or  over  on  five  days.  There  has  been  no  such  record  as  this  in  any  year  since 
IQOO,  the  nearest  approach  being  1909,  as  already  mentioned. 

The  years  1901  and  1911  each  had  a  prolonged  hot  spell  in  July.  In  the 
former  year,  at  6  a.m.  on  July  1st,  the  temperature  was  81°  and  did  not  fall  below 
80°  until  2  P.M.  on  the  third,  a  period  of  fifty-six  hours,  when  between  1  p.m.  and 
6  P.M.  there  was  a  hard  storm,  the  thermometer  falling  from  94°  to  77°  in  one 
hour.  From  11  a.m.  to  9  p.m.  on  the  first,  from  9  A.M.  to  6  p.m.  on  the  second,  and 
from  10  A.M.  to  1  p.m.  on  the  third,  the  temperature  registered  90  or  over  and 
reached  100°  on  the  first  and  second.  Then  followed  cooler  weather.  There 
was  a  period  of  high  temperature  from  July  14th  to  17th  inclusive;  August  21st 
to  24th  inclusive,  and  August  29th  and  30th,  but  the  temperature  did  not  reach 
such  great  heights,  nor  did  it  remain  so  high  during  the  entire  twenty-four  hours. 
During  the  month  of  July,  1901,  there  were  2404  deaths  under  one  year  of  age. 
In  the  week  ending  July  6,  1901,  617. 

In  July,  1911,  during  the  first  thirteen  days,  there  was  a  period  of  extreme 
heat.  From  10  a.m.  on  the  morning  of  the  second  to  7  p.m.  on  the  evening  of  the 
seventh,  a  total  of  one  hundred  and  twenty-nine  hours,  the  temperature  was 
recorded  below  80°  for  only  twenty-six  hours.  From  3  p.m.  to  9  p.m.  on  the 
second,  9  a.m.  to  9  p.m.  on  the  third,  11  a.m.  to  8  p.m.  on  the  fourth,  12  m.  to 
9  P.M.  on  the  fifth,  11  a.m.  to  8  p.m.  on  the  sixth,  it  was  continually  at  90°  or 
over;  then  came  thirty-nine  hours  of  relief,  to  be  followed  by  another  period  of 
extreme  heat.  From  10  a.m.  on  the  ninth,  to  10  p.m.  on  the  thirteenth,  a  total  of 
one  hundred  and  eight  hours,  the  temperature  was  below  80°  only  twenty-three 
hours.  From  3  p.m.  to  8  p.m.  on  the  ninth,  11  a.m.  to  5  p.m.  on  the  tenth,  12  m. 
to  9  P.M.  on  the  eleventh,  4  p.m.  to  9  p.m.  on  the  twelfth,  it  was  continually  90° 
or  over,  and  yet  during  the  month  of  July,  1911,  only  1530  babies  died,  compared 
with  2404  in  1901.  In  the  week  ending  July  8,  1911,  only  347  babies  died,  com- 
pared with  617  in  1901.  This  remarkable  failure  of  the  infant  deaths  to  rise 
promptly  and  markedly  during  the  hot  weather  is  even  more  strikingly  shown  in 
Exhibits  6  and  8,  which  show  the  daily  deaths  in  Manhattan  and  Brook- 
lyn during  this  hot  period.  On  no  day  in  the  entire  summer  did  the  deaths  in 
Manhattan  reach  40.  In  1909,  on  the  other  hand,  57,  and  in  1910,  65,  deaths 
were  recorded  in  a  single  day.  The  hot  period  in  1901,  while  it  lasted  a  shorter 
time,  was  a  little  more  intense  in  that  the  temperature  did  not  fall  below  80°  for 
fifty-six  hours.  In  1911,  in  the  early  mornings,  between  2  and  7  or  8  a.m.,  the 
thermometer  registered  77°  to  80°,  but  its  effect  on  the  thoroughly  baked  tene- 
ments could  not  have  been  great. 

When  we  come  to  consider  the  subject  of  rainfall  and  the  number  of  rainy 
days  occurring  during  these  years,  several  points  must  be  emphasized.  The  total 
rainfall  for  the  month,  so  far  as  its  bearing  upon  health  conditions  may  be  con- 


RESULTS  OF  THE  CAMPAIGN  IN  NEW  YORK  CITY      51 

cerned,  must  be  considered  as  to  its  distribution  throughout  the  month,  as  well  as 
its  total  amount.  For  instance,  August,  1911,  had  a  total  rainfall  of  9.28  inches, 
as  against  1.07  in  1910,  but  up  to  and  including  the  twenty-third  only  1.95  inches 
had  fallen  in  1911,  as  against  0.89  in  1910. 

Table  26  shows  the  monthly  rainfall  and  the  number  of  rainy  days  in  each 
month  for  the  years  we  have  been  considering,  and  also  the  rainfall  from  July  1st 
to  August  23d  inclusive. 

TABLE  26.— RAINFALL  AND  RAINY  DAYS,  NEW  YORK  CITY 

RAINFALL,  INCHES 


Average,  Forty-two  Years 


June 3.29 

July 4.38 

August 4.54 

September 3.62 


1901 


LOO 
7.64 
6.55 

2.42 


1903 


9.78 
3.93 
7.85 
4.31 


1908 


L27 
3.80 
6.01 
1.91 


1909 


3.02 
2.17 
8.50 
2.65 


1910 


6.03 
0.49 
1.07 
1.42 


1911 


5.67 
2.16 
9.28 
1.70 


Total. 


.15.83  17.61         25.87         12.99 

NUMBER  OF  RAINY  DAYS 


16.34 


June 9 

July 10 

August 9 

September 8 


Total  . 


.36 


RAINFALL,*  JULY  1ST  TO  AUGUST  23D,  INCHES 


9.01 


5 

18 

3 

10 

12 

16 

10 

7 

5 

6 

9 

11 

10 

8 

11 

12 

6 

3 

7 

5 

42 

45 

23 

30 

34 

18.81 


14 

11 

12 

9 


46 


July 

August 

7.64 
4.05 

3.93 
3.66 

3.80 
2.59 

2.17 
8.50 

0.49 
0.89 

2.16 
1.95 

Total 

11.69 

7.59 

6.39 

10.67 

1.38 

4.11 

It  will  be  seen  that  during  the  entire  period,  1911  had  a  greater  precipitation 
than  any  of  the  three  previous  years,  slightly  greater  than  in  1901,  and  less  than 
in  1903.  The  number  of  rainy  days  was  greater  than  in  any  of  the  five  other 
years  considered,  although  during  the  period  July  1st  to  August  23d  the  rainfall 
was  lower  than  in  any  of  the  five  years  except  1910.  We  must,  therefore,  admit 
that  in  1911  the  rainfall  and  number  of  rainy  days  were  in  favor  of  low  mortality, 
as  compared  with  1910,  during  the  latter  part  of  the  summer.  During  July  and 
the  first  part  of  August  climatic  conditions  were  unfavorable. 

In  a  general  way  summers  having  bad  climatic  conditions  had  a  high  infant 
mortality.  During  1911  these  conditions  were  unfavorable,  especially  during 
July.  This  Committee  believes  that  the  reduction  in  the  mortality  in  the  summer 
of  1911  was  not  due  to  "chance"  variation  in  mortality,  but  to  increased  effi- 
ciency in  the  methods  used  to  combat  it. 


New  York  Meteorological  Observatory  figures. 


CHAPTER  V 

The  Results  at  the  Milk  Stations  of  the  New  York 
Milk  Committee 

The  results  of  the  work  of  the  Milk  Stations  may  be  gauged  to  a  certain 
extent  by  the  response  of  the  communities  in  which  the  stations  were  located ;  by 
the  mortality  among  the  babies  within  their  spheres  of  influence;  and  by  the 
mortality  among  the  station  babies. 

In  order  to  obtain  these  figures  a  vast  amount  of  statistical  work  had  to  be 
done,  and  it  was  impossible  to  carry  it  out  for  all  the  stations  in  Greater  New  York. 
The  work  was,  therefore,  limited  to  the  stations  maintained  by  the  Milk  Commit- 
tee. 

It  has  already  been  stated  that  the  response  to  the  work  was  so  great  at 
most  of  the  stations  that  extra  nurses  and  sometimes  extra  matrons  had  to  be 
provided.  In  20  stations  an  extra  nurse  was  provided,  and  in  15  an  extra  assistant. 
Table  27  shows  the  enrolment  of  babies  actually  under  supervision  at  the  end  of 
each  week  from  May  20th  to  the  end  of  the  season. 

In  order  to  estimate  the  mortality  among  the  babies  in  the  areas  under  the 
influence  of  the  milk  stations,  the  following  method  was  adopted:  A  map  was 
made  and  plotted  out  showing  the  location  of  the  station  and  the  number  of 
babies  enrolled  in  each  block  surrounding  the  station.  In  this  way  the  actual 
sphere  of  influence  of  the  station  was  determined.  A  few  babies  came  from  longer 
distances,  and,  therefore,  from  outside  the  district.  In  order  to  determine  the 
mortality  in  the  district  thus  established  a  search  of  the  records  at  the  Health 
Department  and  a  tabulation  of  all  deaths  occurring  in  the  months  of  June  to 
November  were  made  for  the  years  1910-1911.  In  order  to  determine  the  infant 
mortality  rates  it  was  necessary  to  tabulate  the  births  by  blocks  in  the  same  areas. 
The  Committee  originally  intended  to  close  its  work  on  October  1st,  so  that  the 
births  were  tabulated  for  the  years  October  1,  1909,  to  September  30,  1910;  and 
October  1,  1910,  to  September  30,  1911.  The  deaths  were  originally  tabulated 
from  January  1st  to  September  30th,  but  it  seemed  more  accurate  to  take  only 
the  five  months  of  active  work,  and  this  tabulation  was  made  a  second  time.  It 
was,  however,  impossible  to  go  through  the  birth  figures  again. 

The  following  table  shows  the  deaths  under  one  year  for  the  "Station  Areas" 
in  the  months  June  to  October  inclusive  in  1910,  before,  and  in  1911,  after,  sta- 
tions were  maintained.  It  should  be  remembered  that  the  stations  at  Mulberry, 
Cannon,  East  21st,  and  West  48th  Streets  had  been  running  for  several  years. 
This  table  also  shows  the  births  for  the  twelve  months  ending  September  30th, 
and  the  infant  mortality  rate  based  thereon.     For  comparison  the  death-rate 

52 


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53 


54 


INFANT  MORTALITY  AND  MILK  STATIONS 


among  babies  under  one  year,  based  on  the  enrolment,  is  given  for  each  station; 
also  the  totals  for  East  and  West  Side  stations  and  for  the  total  area. 


TABLE  28.— STATISTICS  OF  STATION  AREAS  AND  STATIONS 

1910 

1911 

Station  Mortality 

Station  Area 
East  Side 

Deaths, 
June- 
Oct. 

Births, 
Oct.- 
Sept. 

Infant 
Mortal- 
ity 

Deaths, 
June- 
Get. 

Births, 
Oct.- 
Sept. 

Infant 
Mor- 
tality 

Deaths, 
June- 
Oct. 

Enrol- 
ment 

Death- 
rate 

1.  Mulberry 

42 
16 
39 

78 
65 
58 
33 
55 
53 
53 
90 
92 
20 
47 
37 
30 
24 
53 
110 
13 

'27 
27 

1307 

601 

1305 

1909 

1130 

1219 

883 

1011 

598 

831 

1678 

1568 

358 

554 

568 

505 

378 

834 

1593 

349 

373 

738 

32.1 
26.6 
29.8 
40.8 

57.5 
47.5 
37.4 
54.4 
88.6 
63.7 
53.6 
58.6 
55.8 
84.8 
65.1 
59.4 
63.4 
63.5 
69.0 
37.2 

72.3 
36.5 

54 
11 
34 
52 
30 
40 
29 
36 
34 
50 
83 
70 
14 
31 
39 
23 
21 
40 
84 
10 

'i4 

25 

1343 

580 

1374 

1777 

1013 

1199 

830 

911 

561 

786 

1663 

1556 

366 

553 

605 

471 

397 

783 

1631 

338 

366 
776 

43.4 

18.9 
26.6 
29.2 
29.6 
33.3 
35.3 
39.5 
60.6 
63.6 
49.9 
44.9 
38.2 
56.0 
64.4 
48.8 
52.8 
51.0 
51.5 
29.5 

38.'2 
32.2 

12 
0 
2 
6 
0 
1 
7 
3 
5 
6 

14 
5 
1 
4 
9 
5 
6 
6 
8 
2 

"2 
0 

356 
133 
307 
430 
155 
153 
143 
158 
187 
305 
399 
383 
111 
176 
170 
135 
135 
367 
198 
134 

ioi 

189 

46.8 

2.  Norfolk 

0.0 

3.  Eldridge 

9.6 

4.  Cannon  and  Stanton  (21) 

5.  Ludlow 

13.9 
0.0 

6.  East  3d 

6.5 

7.  East  5th 

49.3 

8.  East  9th  .  .:i. 

9.  East  21st 

18.9 
26.7 

10.  Avenue  A 

29.2 

11.  East  105th 

46.8 

12.  East  11th 

17.6 

13.  East  56th 

9.0 

14.  512  2d  Ave 

22.7 

15.  873  2d  Ave 

52.9 

16.  E.  81st  St 

37.0 

17.  1705  2d  Ave 

44.4 

18.  E.  97th 

22.4 

19.  E.  112th 

40.4 

20.  E.  115th 

14.9 

21.  Combined  with  4 

22.  E.  75th  

19!8 

23.  Madison  Ave 

0.0 

Total  East  Side  .  . 

1062 

20389 

52.3 

824 

19668 

41.8 

104 

4314 

24.6 

1910 

1911 

Station  Mortality 

Station  Area 
West  Side 

Deaths, 
June- 
Oct. 

Births, 
Oct.- 
Sept. 

Infant 
Mortal- 
ity 

Deaths, 
June- 
Get. 

Births, 
Gct.- 
Sept. 

Infant 
Mor- 
tality 

Deaths, 
June- 
Get. 

Enrol- 
ment 

Infant 
Mor- 
tality 

1.  Thompson 

42 
40 
54 
127 
32 
33 
59 
44 

917 
550 
639 
1360 
375 
333 
545 
373 

45.8 

72.7 

85.8 

93.3 

85.3 

148.5 

108.2 

117.9 

47 
32 
46 
101 
25 
24 
44 
19 

861 

555 

534 

1409 

378 
242 
481 
365 

54.5 
57.6 
87.7 
71.7 
66.1 
99.1 
91.4 
52.0 

4 
10 
8 
7 
2 
5 
2 
3 

236 
129 
117 
198 
91 
121 
139 
134 

16.9 

2.  Leroy 

77.5 

3.  10th  Ave 

68.3 

4.  W.  48th 

35.3 

5.  W.  69th 

21.9 

6.  Washington 

41.3 

7.  Vanderbilt  Clinic 

8.  9th  Ave 

14.3 
22.3 

Total  West  Side  . 
East  Side 

431 

1062 
431 

4971 

30289 
4971 

86.6 

52.3 
86.6 

338 

824 
338 

4815 

19668 
4815 

70.2 

41.8 
70.2 

41 

104 
41 

1165 

4214 
1165 

35.1 
24.6 

West  Side 

35.1 

All  Areas 

1493 

25260 

59.0 

1162 

24483 

47.4 

145 

5379 

26.9 

It  will  be  seen  that  in  the  station  areas  on  the  East  Side  there  was  a  reduction 
of  10.5  over  1910,  and  on  the  West  Side,  16.4.  The  infant  population  affected 
on  the  West  Side,  however,  was  about  one-quarter  that  of  the  East  Side.     This 


THE  RESULTS  AT  THE  MILK  STATIONS  55 

would  seem  to  point  either  to  less  efficient  station  technic  or  to  a  poorer  class  of 
patients,  i.  e.,  needing  the  stations  more.  Comparing  the  station  rate  and  the 
district  rate,  the  latter  conclusion  is  borne  out,  for  on  the  West  Side  the  station 
rate  was  just  half  the  district  rate.  The  testimony  of  the  nurses  and  physicians 
in  charge  of  the  stations  also  points  to  this  being  the  case. 

Another  noticeable  fact  is  that  in  the  Mulberry  Street,  East  5th  Street,  and 
Leroy  Street  stations  the  station  mortality  is  in  excess  of  the  district  mortality. 
This  is  explained  by  the  fact  that  the  nurses  in  these  districts  were  particularly 
active  in  seeking  out  sick  babies;  also  by  the  particularly  bad  character  of  the 
neighborhood  in  which  at  least  two  of  the  stations  (East  5th  Street  and  Leroy 
Street)  were  situated.  Although  many  of  these  babies  were  seen  only  once  and 
cannot  be  fairly  charged  against  the  station,  the  Committee  adopted  the  policy 
of  accepting  the  responsibility  for  the  death  of  every  baby  enrolled,  even  if  seen 
only  once,  in  order  to  avoid  criticism,  and  it  stands  on  these  records  as  given. 

The  West  Side  figures  show  the  great  need  of  stations  in  this  part  of  the  city. 
The  areas  of  intensely  congested  population  are  more  scattered ;  there  is  not  the 
long  stretch  that  is  seen  on  the  East  Side,  and  this  part  of  the  city  has  been  neg- 
lected. In  only  4  of  the  23  East  Side  station  areas  does  the  death-rate  equal  or 
exceed  the  lowest  one  on  the  West  Side.  In  4  of  the  West  Side  districts  the  rates 
are  higher  than  those  of  the  worst  East  Side  district. 

Some  of  the  figures  are  very  striking.  In  the  Washington  Street  district, 
among  the  Syrian  population,  the  death-rate  in  1910  was  148.5,  and  fell  in  1911  to 
99.1,  a  net  difference  of  49.4.  This  little  strip  of  densely  populated  territory 
extends  from  Battery  Place  to  Cedar  Street,  from  West  Side  to  Greenwich. 
The  people  rarely  speak  English,  and  an  interpreter  was  needed  almost  all  the 
time.  Two  hundred  and  forty-two  babies  were  born  in  the  year,  and  the  enrol- 
ment was  121,  or  exactly  50  per  cent.,  while  the  station  death-rate  was  41.3,  or 
41.6  per  cent,  of  the  district  mortality. 

Table  29,  while  not  strictly  accurate,  is  suggestive  for  purposes  of  compari- 
son. If  the  enrolment  be  deducted  from  the  district  births,  and  the  station 
deaths  from  the  district  deaths,  the  comparison  is  even  more  striking. 

This  is  not  strictly  accurate,  because  the  enrolment  was  not  absolutely  con- 
fined to  the  station  area  of  influence.  For  instance,  at  the  East  105th  Street 
station  several  enrolled  babies  lived  in  the  Bronx.  The  station  where  the  figures 
did  most  closely  correspond  was  probably  Washington  Street,  which  shows  a 
mortality  of  41.3  as  against  the  "corrected"  rate  of  157  for  the  district. 

Another  suggestive  table,  again  not  strictly  accurate  for  the  same  reason,  but 
not  more  than  1  or  2  per  cent,  out,  is  Table  30,  showing  the  percentage  of 
births  enrolled  at  the  stations  and  the  percentage  of  the  district  deaths  among 

babies  enrolled. 

One  of  the  objects  of  the  demonstration  carried  on  by  the  New  York  Milk 
Committee  in  cooperation  with  other  organizations  was  to  show  that  home  modi- 
fication was  practicable  among  the  very  poor  and  ignorant,  among  whom  the 
work  was  done.  The  Committee  felt  very  strongly  that  not  only  was  this  a  more 
practical  way,  because  less  expensive,  but  that  it  accomplished  more  in  that  it 
taught  something. 


56 


INFANT  MORTALITY  AND  MILK  STATIONS 


TABLE   29— STATISTICS  FOR  STATION  AREAS,  DEDUCTING  STATION   ENROL- 
MENT FROM  DISTRICT  BIRTHS,  AND  STATION  DEATHS  FROM   DISTRICT 
DEATHS,  COMPARED  WITH  STATION  FIGURES 


Station  Districts 

Stations 

Deaths 

Births 

Rate 

Deaths 

Enrolment 

Rate 

IE 

42 
11 
32 
46 
30 
39 
22 
33 
29 
44 
69 
65 
13 
27 
30 
18 
15 
34 
76 
8 

12 
25 

987 

457 

1067 

1347 

857 

1046 

678 

753 

374 

581 

1364 

1273 

255 

377 

435 

336 

262 

516 

1433 

204 

265 

587 

42.5 

24.0 

29.9 

34.1 

35.0 

27.2 

32.4 

43.8 

77.5 

75.7 

50.5 

51.0 

50.9 

71.6 

68.9 

53.5 

57.2 

65.8 

53.0  > 

39.2 

45.2 

42.5 

12 
0 
2 
6 
0 
1 
7 
3 
5 
6 

14 
5 
1 
4 
9 
5 
6 
6 
8 
2 
2 
0 

256 
123 
207 
430 
155 
153 
142 
158 
187 
205 
299 
283 
111 
176 
170 
135 
135 
267 
198 
134 
101 
189 

46.8 

2  E 

0.0 

3  E 

9.6 

4  and  21  E 

13.9 

5  E 

0.0 

6E 

6.5 

7  E 

49.3 

8  E 

18.9 

9  E 

26.7 

10  E 

29.2 

HE ^ 

46.8 

12  E 

17.6 

13  E 

9.0 

14  E 

22.7 

15  E 

52.9 

16  E 

37.0 

17  E 

44.4 

18  E 

22.4 

19  E 

40.4 

20  E 

14.9 

22  E 

19.8 

23  E 

0.0 

Total  East  Side 

720 

15454 

46.5 

104 

4214 

24.6 

1  W 

43 
22 
38 
94 
23 
19 
42 
16 

625 
426 
407 
1211 
287 
121 
342 
231 

68.8 
51.6 
93.3 
77.6 
80.1 
157.0 
122.8 
69.2 

4 
10 
8 
7 
2 
5 
2 
3 

236 
129 
117 
198 
91 
121 
139 
134 

16.9 

2  W 

77.5 

3  W 

68.3 

4  W 

35.3 

5  W 

21.9 

6  W 

41.3 

7  W 

14.3 

8  W 

22.3 

Total  West  Side 

297 

3650 

81.3 

41 

1165 

35.1 

Summary 

East  Side 

720 
297 

15454 
3650 

46.5 
81.3 

104 
41 

1 

4214 
1165 

24.6 

West  Side 

35.1 

Total 

1017 

19104 

53.2 

1 

145 

5379 

26.9 

With  this  point  in  view,  careful  records  were  kept  of  each  case,  and  from  the 
individual  records  the  following  tables  (Tables  31  to  42)  have  been  compiled, 
showing  in  some  detail  the  feeding  history  of  3182  babies.  The  period  of  observa- 
tion extended  from  June  1st  to  September  15th.  The  latter  date  was  selected 
in  order  that  something  definite  might  be  compiled  for  the  Board  of  Estimate  and 
Apportionment.  If  the  full  time — June  1st  to  November  1st — could  have  been 
utilized  for  these  records,  the  results  might  have  been  even  better,  as  many  babies 
were  recorded  as  well  at  the  end  who  showed  no  gain  in  weight. 


THE  RESULTS  AT  THE  MILK  STATIONS  57 

TABLE  30.— RELATION  OF  ENROLMENT  AT  STATION  TO  BIRTHS   IN  DISTRICT 
AND  STATION  DEATHS  TO  DISTRICT  DEATHS 

Station  Districts  Percentage  of  Percentage  of  District 

Births  Enrolled  Deaths  Among  Enrolled 

East  Side 

1.... 20.5  22.2 

2 21.2  0.0 

3 16.2  5.8 

4  and  21 24.2  11.5 

5 15.3  0.0 

6 12.7  2.5 

7 17.3  24.1 

8 17.3  8.3 

9 33.3  14.7 

10 26.0  12.0 

11 17.9  16.8 

12 18.1                              .  7.1 

13 30.3  6.8 

14 31.8  12.9 

15 28.0  23.0 

16 28.6  21.7 

17 34.0  28.5 

18 34.0  15.0 

19 12.1  9.5 

20 39.6  20.0 

22 27.5  14.2 

23 24.3  0.0 

21.4  12.6 
West  Side 

1 27.4  8.5 

2 23.2  31.2 

3 22.3  17.3 

4 14.0  6.9 

5 24.0  8.0 

6 50.0  20.8 

7 28.9  4.5 

8 36.7  15.7 

24.2  12.1 

Grand  Total 21.9  12.4 

With  reference  to  the  condition  of  "well"  or  "sick"  at  the  close  of  the  period, 
the  criticism  may  be  made  that  overenthusiasm  of  the  physicians  and  nurses  may 
have  made  the  well  too  many,  and  the  sick  too  few.  This  criticism  cannot  be 
disproved,  but  even  leaving  out  of  all  consideration  the  statement  of  "well"  or 
"sick,"  the  weights,  which  show  pretty  conclusively  the  success  or  failure  of 
feeding,  cannot  be  questioned.  They  must  be  regarded  as  accurate  and  as  free 
from  error  due  to  the  personal  equation. 

In  considering  the  following  tables,  noting  the  "condition  at  close,"  it  must 
be  remembered  that  the  period  of  observation  was  short, — an  average  of  six  weeks. 
— and  many  babies  classed  as  well  did  not  have  a  chance  to  gain  in  weight.  Every 
baby  enrolled  more  than  a  week  is  included  in  this  record.  Fatal  cases  are  in- 
cluded in  the  tables,  although  no  data  are  given.  These  cases  are  considered  in 
detail  elsewhere.  As  no  babies  who  did  not  attend  a  week  or  over  are  included 
in  the  table,  the  number  of  deaths  is  only  74  instead  of  119,  as  45  babies  were 
seen  only  once  and  immediately  referred  to  a  hospital  or  private  physician,  or  else 
the  mother  refused  to  attend. 


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72 


THE  RESULTS  AT  THE  MILK  STATIONS 


73 


It  is  also  to  be  remembered,  in  studying  these  tables,  that  the  period  of  ob- 
ervation  was  during  the  hottest  summer  weather.  The  gain  in  weight  is  very 
triking.  This  is  most  marked  among  the  breast-fed  babies,  as  would  be  ex- 
lected.  It  is  also  interesting  to  note  the  average  weights  of  the  babies  under  one 
ear.  In  the  group  over  one  year  it  will  be  noted  that  they  were  practically  all 
rery  much  under  normal  weight  when  admitted,  and  that  the  gains  were  con- 
iderable. 

Summary  Tables  44  and  45  show  the  condition  of  babies  at  the  close  of  the 
)eriod  of  observation,  grouped  according  to  age,  sick  or  well  on  admission,  and 
otal,  expressed  in  gross  and  percentage  figures. 

I        As  would  be  expected,  the  results  for  babies  well  on  admission  are  much 

r^etter  than  for  sick  babies.     In  the  former  group,  87.5  per  cent,  showed  gain  in 

veight,  as  against  76.8  per  cent,  in  the  latter,  the  average  being  84.8  per  cent. 

«\gain,  95.4  per  cent,  of  the  well  babies  were  well  at  the  close,  3.5  per  cent,  were 

iick,  and  1.1  per  cent,  had  died. 

Of  the  sick  babies,  50.1  per  cent,  were  well,  44.1  per  cent,  were  still  sick,  and 
mly  5.8  per  cent,  had  died.  That  over-optimism  did  not  make  the  "well"  too 
ligh  may  be  gathered  from  the  relation  of  gain  in  weight  and  "well"  among  the 
iick  babies. 

A  more  detailed  discussion  of  the  deaths  will  be  given  later  on  in  this  chapter. 
The  following  table  shows  the  condition  of  babies  on  admission,  grouped 
iccording  to  feeding  history,  and  further  divided  into  groups  of  babies  under 
)ne  year  and  over  one  year  of  age. 


FABLE  46.— SUMMARY  OF  FEEDING  HISTORIES  AND  CONDITION  ON  ADMISSION 


Feeding 

Under  One 

Over  One 

Total 

Breast 

Well 

Sick 

Total 

Well 

Sick 

Total 

WeU 

Sick 

Total 

608 

140 

54 

83 
24 
16 

691 

164 
70 

60 
23 
31 

17 
3 
3 

77 
26 
34 

668 
163 

85 

100 
27 
19 

768 

Breast  to  mixed 

190 

Breast  to  artificial 

104 

Total  breast  on  admission 

802 

123 

925 

114 

23 

137 

916 

146 

1062 

Mixed 

329 
26 

108 
9 

437 
35 

98 
19 

60 
13 

158 
32 

427 
45 

168 
22 

595 

Mixed  to  artificial 

67 

Total  mixed  on  admission 

355 

117 

472 

117 

73 

190 

472 

190 

662 

Artificial 

451 

284 

735 

529 

194 

723 

980 

478 

1458 

Total 

1608 

524 

2132 

760 

290 

1050 

2368 

814 

3182 

74  INFANT  MORTALITY  AND  MILK  STATIONS 

Of  3182  babies  at  end  of  period — 

2697,  or  84.87  per  cent.,  showed  gain  in  weight. 
2666,  or  83.8    per  cent.,  were  well. 
74,  or    2.3    per  cent.,  had  died. 

Of  3182  babies  on  admission — 

2368,  or  74.4    per  cent.,  were  well. 
814,  or  25.6    per  cent.,  were  sick. 

Of  2368  babies  well  on  admission,  at  end  of  period — 

2072,  or  87.5    per  cent.,  showed  gain  in  weight. 
2258,  or  95.4    per  cent.,  were  well. 
27,  or    1.1    per  cent.,  had  died. 

Of  814  babies  sick  on  admission,  at  end  of  period — 

625,  or  76.8    per  cent.,  showed  gain  in  weight. 
408,  or  50.1    per  cent.,  were  well. 
47,  or    5.8    per  cent.,  had  died. 

TABLE  47.— NUMBER  OF  BABIES  GROUPED  ACCORDING  TO  FEEDING  HISTORY, 

NUMBER  SICK  AND  WELL  ON  ADMISSION,  AND  PERCENTAGES  OF  TOTAL 

ENROLMENT  FOR  EACH  GROUP  AND  CONDITION 


Breast-fed 

Breast-fed 

TO  Mixed 

Fed 

Breast-fed 
TO  Artifi- 
cially Fed 

Mixed  Fed 

Mixed  Fed 
TO  Artifi- 
cially Fed 

Artifi- 
cially Fed 

Totals 

No. 

Per 
Cent. 

No. 

Per 
Cent. 

No. 

Per 
Cent. 

No. 

Per 
Cent. 

No. 

Per 
Cent. 

No. 

Per 
Cent. 

No. 

Per 
Cent. 

Well 

Sick 

668 
100 

21.0 
3.1 

163 
27 

5.1 
0.8 

85 
19 

2.7 
0.6 

427 
168 

13.4 
5.3 

45 
22 

1.4 
0.7 

980 

478 

30.8 
15.0 

2368 
814 

74.4 
25.6 

Total 

768 

24.1 

190 

5.9 

104 

3.3 

595 

18.7 

67 

2.1 

1458 

45.8 

3182 

99.9 

TABLE  48.— FEEDING  HISTORY  AND  PROPORTION  OF  EACH  GROUP,  SICK  OR 

WELL  ON  ADMISSION 


Breast-fed 

Breast-fed 

TO  Mixed 

Fed 

Breast-fed 
TO  Artifi- 
cially Fed 

Mixed  Fed 

Mixed  Fed 
TO  Artifi- 
cially Fed 

Artifi- 
cially Fed 

Totals 

No. 

Per 
Cent. 

No. 

163 

27 

Per 
Cent. 

No. 

Per 
Cent. 

No. 

Per 
Cent. 

No. 

Per 
Cent. 

No. 

980 

478 

1458 

Per 
Cent 

No. 

Per 
Cent. 

Well 

668 
100 

87.0 
13.0 

85.8 
14.2 

85 
19 

81.7 
18.3 

427 
168 

595 

71.8 
28.2 

45 
22 

67 

67.2 
32.8 

67.2 
32.8 

2368 
814 

74.4 
25.6 

Sick 

Total 

768 

100.0 

190 

100.0 

104 

100.0 

100,0 

100.0 

100.0 

3182 

100.0 

Nearly  one-quarter  of  the  entire  enrolment,  therefore,  were  breast-fed 
throughout,  and  30  per  cent,  were  entirely  or  partially  nursed.  The  ratio  of  sick 
to  well  increases  from  breast-fed  to  mixed  fed  to  artificially  fed. 


THE  RESULTS  AT  THE  MILK  STATIONS 


75 


^ABLE  49— PROPORTION  OF  TOTAL    BABIES   BREAST-FED,  MIXED   FED,  AND 
ARTIFICIALLY  FED  ON  ADMISSION 


Breast 


No. 


1062 


Per  cent. 


33.4 


Mixed 


No. 


662 


Per  cent. 


20.8 


Artificial 


No. 


1458 


Per  cent. 


45.8 


Of  1062  babies  breast-fed  on  admission — 

768,  or  72.3  per  cent.,  were  breast-fed  throughout;  at  end  of  period — 
704,  or  91.7  per  cent.,  showed  gain  in  weight. 
699,  or  91.0  per  cent.,  were  well. 
5,  or    0.47  per  cent.,  had  died. 
190,  or  17.9  per  cent.,  were  changed  to  mixed  feeding;  at  end  of  period — 
171,  or  90.0  per  cent.,  showed  gain  in  weight. 
167,  or  87.9  per  cent.,  were  well. 
None  had  died. 
104,  or  9.8  per  cent.,  were  changed  to  artificial  feeding;  at  end  of  period — 
90,  or  86.5  per  cent.,  showed  gain  in  weight. 
97,  or  93.3  per  cent.,  were  well. 
None  had  died. 
Of  662  babies  mixed  fed  on  admission — 

595,  or  89.9  per  cent.,  were  mixed  fed  throughout;  at  end  of  period — 
497,  or  83.5  per  cent.,  showed  gain  in  weight. 
460,  or  77.3  per  cent.,  were  well. 
19,  or    3.2  per  cent.,  had  died. 
67,  or  10.1  per  cent.,  were  changed  to  artificial  feeding;  at  end  of  period — 
51,  or  76.1  per  cent.,  showed  gain  in  weight. 
53,  or  79.1  per  cent.,  were  well. 
6,  or    9.0  per  cent.,  had  died. 
Of  1458  babies  artificially  fed  on  admission;  at  end  of  period — 
1184,  or  81.2  per  cent.,  showed  gain  in  weight. 
1190,  or  81.6  per  cent.,  were  well. 
44,  or    3.0  per  cent.,  had  died. 

TABLE  50.— PROPORTION  OF  TOTAL  BABIES  WELL  OR  SICK  ON  ADMISSION  AC- 
CORDING TO  FEEDING  ON  ADMISSION 


Breast-fed 

Mixed  Fed 

Artificially  Fed 

No. 

Per  Cent. 

No. 

Per  Cent. 

No. 

Per  Cent. 

NeW 

916 
146 

86.3 
13.7 

472 
190 

71.3 
28.7 

980 
478 

67.2 

iick 

32.8 

rOTAL  

1062 

100.0 

662 

100.0 

1458 

100.0 

Of  916  babies  well  and  breast-fed  on  admission — 

668,  or  72.9  per  cent.,  were  breast-fed  throughout;  at  end  of  period — 
624,  or  93.4    per  cent.,  showed  gain  in  weight. 
647,  or  96.8    per  cent.,  were  well. 
3,  or    0.45  per  cent.,  had  died. 


76  INFANT  MORTALITY  AND  MILK  STATIONS 

163,  or  17.8  per  cent.,  were  changed  to  mixed  feeding;  at  end  of  period — 
146,  or  89.6  per  cent.,  showed  gain  in  weight. 
150,  or  92.0  per  cent.,  were  well. 
None  had  died. 
85,  or  9.3  per  cent.,  were  changed  to  artificial  feeding;  at  end  of  period — 
73,  or  85.0  per  cent.,  showed  gain  in  weight. 
83,  or  97.6  per  cent.,  were  well. 
None  had  died. 
Of  472  babies  well  and  mixed  fed  on  admission — 

427,  or  90.5  per  cent.,  were  mixed  fed  throughout;  at  end  of  period — 
371,  or  86.9  per  cent.,  showed  gain  in  weight. 
400,  or  93.7  per  cent.,  were  well. 
8,  or    1.9  per  cent.,  had  died. 
45,  or  9.5  per  cent.,  were  changed  to  artificial  feeding;  at  end  of  period — 
34,  or  75.5  per  cent.,  showed  gain  in  weight. 
38,  or  84.4  per  cent.,  were  well. 
4,  or    9.1  per  cent.,  had  died. 
Of  980  babies  well  on  admission  and  artificially  fed  throughout;   at  end  of 

period — 

824,  or  84.1  per  cent.,  showed  gain  in  weight. 
940,  or  95.9  per  cent.,  were  well. 
12,  or    1.2  per  cent.,  had  died. 
Of  146  babies  sick  and  breast-fed  on  admission — 

100,  or  68.5  per  cent.,  were  breast-fed  throughout;  at  end  of  period — 
80,  or  80  per  cf^nt.   showed  gain  in  weight. 
52,  or  52  per  cent.,  were  well. 
2,  or    2  per  cent.,  had  died. 
27,  or  18.5  per  cent.,  were  changed  to  mixed  feeding;  at  end  of  period — 
25,  or  92.6  per  cent.,  showed  gain  in  weight. 
17,  or  63.0  per  cent.,  were  well. 
None  had  died. 

19,  or  13  per  cent.,  were  changed  to  artificial  feeding;  at  end  of  period — 
17,  or  89.5  per  cent.,  showed  gain  in  weight. 

14,  or  73.7  per  cent.,  were  well. 
None  had  died. 

Of  190  babies  sick  and  mixed  fed  on  admission — 

168,  or  88.4  per  cent.,  were  mixed  fed  throughout;  at  end  of  period — 
126,  or  75.0  per  cent.,  showed  gain  in  weight. 
60,  or  35.7  per  cent.,  were  well. 
11,  or    6.6  per  cent.,  had  died. 
22,  or  11.6  per  cent.,  were  changed  to  artificial  feeding;  at  end  of  period — 
17,  or  77.3  per  cent.,  showed  gain  in  weight. 

15,  or  68.2  per  cent.,  were  well. 

2,  or    9.1  per  cent.,  had  died.  \ 

Of  478  babies  sick  on  admission  and  artificially  fed  throughout;   at  end  of 
period — 

360,  or  75.3  per  cent.,  showed  gain  in  weight. 
250,  or  52.3  per  cent.,  were  well. 
32,  or    6.7  per  cent.,  had  died. 

The  above  figures  are  for  babies  under  two  years  of  age.     It  may  be  well 
to  study  the  results  of  the  feeding  in  the  2132  babies  under  one  year  of  age. 


THE  RESULTS  AT  THE  MILK  STATIONS 

Of  2132  babies  under  one  year  of  age,  at  end  of  period — 
1844,  or  86.5  per  cent.,  showed  gain  in  weight. 
1796,  or  84.2  per  cent.,  were  well. 
68,  or    3.2  per  cent.,  had  died. 
Of  2132  babies  on  admission — 

1608,  or  75.4  per  cent.,  were  well. 
524,  or  24.6  per  cent.,  were  sick. 
Of  1608  babies  well  on  admission,  at  end  of  period — 
1449,  or  90.1  per  cent.,  showed  gain  in  weight. 
1534,  or  95.4  per  cent.,  were  well. 
22,  or    1.4  per  cent.,  had  died. 
Of  524  babies  sick  on  admission,  at  end  of  period — 
395,  or  75.4  per  cent.,  showed  gain  in  weight. 
262,  or  50     per  cent.,  were  well. 
46,  or    8.8  per  cent.,  had  died. 


n 


TABLE  51.— PROPORTION  OF  TOTAL   BABIES  UNDER  ONE  YEAR  WHO  WERE 
BREAST-FED,  MIXED  FED,  OR  ARTIFICIALLY  FED  ON  ADMISSION 


Breast-fed 

Mixed  fed 

Artificially  fed 

No. 

Per  cent. 

No. 

Per  cent. 

No. 

Per  cent. 

925 

43.4 

472 

22.1 

735 

34.5 

Of  925  babies  breast-fed  on  admission — 

691,  or  74.7  per  cent.,  were  breast-fed  throughout;  at  end  of  period — 
648,  or  93.8    per  cent.,  showed  gain  in  weight. 
634,  or  91.8    per  cent.,  were  well. 
5,  or    0.72  per  cent.,  had  died. 
164,  or  17.7  per  cent.,  were  changed  to  mixed  feeding;  at  end  of  period — 
148,  or  90.2  per  cent.,  showed  gain  in  weight. 
144,  or  87.8  per  cent.,  were  well. 
None  had  died. 
70,  or  7.6  per  cent.,  were  changed  to  artificial  feeding;  at  end  of  period — 
64,  or  91.4  per  cent.,  showed  gain  in  weight. 
63,  or  90.0  per  cent.,  were  well. 
None  had  died. 
Of  472  babies  mixed  fed  on  admission — 

437,  or  92.6  per  cent.,  were  mixed  fed  throughout;  at  end  of  period — 
375,  or  85.8  per  cent.,  showed  gain  in  weight. 
353,  or  80.8  per  cent.,  were  well. 
18,  or    4.1  per  cent.,  had  died. 
35,  or  7.4  per  cent.,  were  changed  to  artificial  feeding;  at  end  of  period — 
27,  or  77.1  per  cent.,  showed  gain  in  weight. 
27,  or  77.1  per  cent.,  were  well. 
6,  or  17.1  per  cent.,  had  died. 
Of  735  babies  artificially  fed  on  admission,  at  end  of  period — 
582,  or  79.2  per  cent.,  showed  gain  in  weight. 
575,  or  78.2  per  cent.,  were  well. 
39,  or    5.3  per  cent.,  had  died. 


78              INFANT  MORTALITY  AND  MILK  STATIONS                  i 

TABLE  52.— PROPORTION    OF  BABIES  UNDER  ONE  YEAR  WHO  WERE  WELL  OP 
SICK  ON  ADMISSION  ACCORDING  TO  FEEDING  ON  ADMISSION 

Breast-fed 

Mixed  Fed 

Artificially  Fed         H 

No. 

Per  cent. 

No. 

Per  Cent. 

No. 

Per  cent.    U 

Wei! 

Sick 

802 
123 

86.7 
13.3 

355 
117 

75.2 
24.8 

541 

284 

lil    1 

Total 925 

100.0 

472 

100.0 

735 

100.0      ■ 

Of  802  babies  well  and  breast-fed  on  admission — 

608,  or  75.8  per  cent.,  were  breast-fed  throughout;  at  end  of  period- 
577,  or  94.9    per  cent.,  showed  gain  in  weight. 
591,  or  97.4    per  cent.,  were  well. 
3,  or    0.49  per  cent.,  had  died. 
140,  or  17.5  per  cent.,  were  changed  to  mixed  feeding;  at  end  of  period- 
126,  or  90.0  per  cent.,  showed  gain  in  weight. 
129,  or  92.1  per  cent.,  were  well. 
None  had  died. 

54,  or  6.7  per  cent.,  were  changed  to  artificial  feeding;  at  end  of  period — 
50,  or  92.6  per  cent.,  showed  gain  in  weight. 
52,  or  96.3  per  rent.,  were  well. 
None  had  died. 
Of  355  babies  well  and  mixed  fed  on  admission — 

329,  or  92.7  per  cent,,  were  mixed  fed  throughout;  at  end  of  period — 
294,  or  89.4  per  cent.,  showed  gain  in  weight. 
308,  or  93.6  per  cent.,  were  well. 
7,  or    2.1  per  cent.,  had  died. 
26,  or  7.3  per  cent.,  were  changed  to  artificial  feeding;  at  end  of  period — 
20,  or  76.9  per  cent.,  showed  gain  in  weight. 
20,  or  76.9  per  cent.,  were  well. 
4,  or  15.4  per  cent.,  had  died. 
Of  451  babies  well  and  artificially  fed  on  admission;  at  end  of  period — 
382,  or  84.7  per  cent.,  showed  gain  in  weight. 
434,  or  96.2  per  cent.,  were  well. 
8,  or  1,8  per  cent.,  had  died. 
Of  123  babies  sick  and  breast-fed  on  admission — 

83,  or  67.5  per  cent.,  were  breast-fed  throughout;  at  end  of  period — 
71,  or  85.5  per  cent.,  showed  gain  in  weight. 
43,  or  51.8  per  cent.,  were  well. 
2,  or  2.4  per  cent.,  had  died. 
24,  or  19.5  per  cent.,  were  changed  to  mixed  feeding;  at  end  of  period — 
22,  or  19.7  per  cent.,  showed  gain  in  weight. 
15,  or  62.5  per  cent.,  were  well. 
None  had  died. 
16,  or  13  per  cent.,  were  changed  to  artificial  feeding;  at  end  of  period — 
14,  or  87.5  per  cent.,  showed  gain  in  weight. 
11,  or  68.7  per  cent.,  were  well. 
None  had  died. 


THE  RESULTS  AT  THE  MILK  STATIONS  79 

Of  117  babies  sick  and  mixed  fed  on  admission — 

108,  or  92.3  per  cent.,  were  mixed  fed  throughout;  at  end  of  period — 

81,  or  75.0  per  cent.,  showed  gain  in  weight. 

45,  or  41.7  per  cent.,  were  well. 

11,  or  10.2  per  cent.,  had  died. 
9,  or  7.6  per  cent.,  were  changed  to  artificial  feeding;  at  end  of  period — 

7,  or  77.8  per  cent.,  showed  gain  in  weight. 

7,  or  77.8  per  cent.,  were  well. 

2,  or  22.2  per  cent.,  had  died. 

Of  the  284  babies  sick  and  artificially  fed  on  admission,  at  end  of  period — 

200,  or  70.4  per  cent.,  showed  gain  in  weight. 
141,  or  49.6  per  cent.,  were  well. 
31,  or  10.9  per  cent.,  had  died. 

The  above  figures  prove  pretty  conclusively  that  the  home  modification  of 
lilk  is  possible  among  the  very  poor  and  ignorant,  and  that  the  results,  when  this 
jeding  is  carefully  ordered  and  careful  supervision  insures  the  instructions  being 
arried  out,  are  as  good  as  when  modified  milk  is  dispensed. 

As  has  been  already  stated,  every  fatal  case  which  was  seen  once  by  the 
hysician  or  nurse  at  the  station  has  been  charged  against  that  station.  This 
5  obviously  unfair,  for  in  practically  every  case  the  mother  was  referred  to  a 
hysician  or  advised  to  take  the  child  to  a  hospital,  arrangements  usually  being 
lade  at  once  by  the  nurse,  and  a  card  given  to  the  mother.  However,  in  order 
hat  no  charge  of  selecting  cases  could  be  made,  all  were  credited  to  the  stations, 
nd  the  general  mortality  rates  for  each  station  and  for  the  stations  as  a  whole 
iclude  these  deaths. 

Of  the  158*  deaths  occurring  among  the  station  babies  during  the  entire 
■eriod  June  to  November,  the  method  of  feeding,  condition  on  admission,  dis- 
position of  the  case,  place  of  death,  average  interval  elapsing  between  last  visit 
nd  date  of  death,  and  age  at  death,  are  shown  in  the  following  detailed  tables, 
rouped  according  to  diagnosis  and  number  of  clinics  attended. 

In  studying  these  tables  it  must  be  remembered  that  the  diagnoses  are  those 
iven  on  the  death-certificates  by  the  reporting  physician.  It  will  be  noted  that 
iarrheal  disease  is  credited  with  79,  or  exactly  50  per  cent,  of  the  total  deaths ; 
lalnutrition,  21,  or  13.3  per  cent.;  respiratory  diseases,  17,  or  10.8  per  cent.; 
ontagious  diseases,  14,  or  8.9  per  cent.;  all  other  diseases,  27,  or  17  per  cent.  In 
his  last  group  there  are  included: 

Diseases  of  cerebrospinal  system 14 

Congenital  debility 2 

Tuberculosis 3 

Congenital  syphilis 1 

Mastoiditis 1 

"  Choked  to  death  " 1 

Unknown 5 

Total 27 

*  The  deaths  given  in  connection  with  the  feeding  tables  are  for  the  period  June  1st  to  Sep- 
ember  15th. 


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82  INFANT  MORTALITY  AND  MILK  STATIONS 

It  is  possible  that,  as  only  four  died  in  the  hospital,  some  of  the  "cerebro- 
spinal diseases"  may  have  been  diarrheal  in  nature. 

The  above  figures  give  a  death-rate  from  the  different  groups  of  causes  as 
follows,  based  on  the  enrolment  of  7919  babies: 

TABLE  54.— DEATH-RATE  FOR  EACH  GROUP  OF  DISEASES 

Diarrheal 8.0  per  thousand 

Malnutrition 2.6  || 

Respiratory 2.1 

Contagious 1-8 

Other  causes 3.4 

In  order  to  get  a  really  accurate  view  of  what  was  accomplished  it  is  necessary 
to  deduct  the  deaths  of  babies  seen  only  once  and  referred  to  hospitals  or  physi- 
cians, numbering  58,  or  26.7  per  cent.  This  leaves  exactly  100  deaths  to  be 
credited  to  the  stations. 

We,  therefore,  have  100  deaths  among  7861  babies  (deducting  58  from  enrol- 
ment totals  under  two  years  of  age),  a  death-rate  of  1.27  per  thousand. 

There  were  charged  against  the  stations  145  deaths  among  babies  under  one 
year,  and  13  deaths  among  babies  between  one  and  two  years.  Of  these  cases 
there  attended  only  one  clinic,  or  were  seen  but  once,  51  under  one  year  and  7 
over  one  year  and  under  two  years. 

Deducting  these  figures  from  the  deaths  and  enrolment  at  the  different  age 
periods  we  have — 
94  deaths  among  5328  babies  under  one  year,  or  17.6  per  thousand. 
6  deaths  among  2533  babies  over  one  year,  and  under  two,  or  2.4  per  thousand. 
The  deaths  under  one  year  in  Manhattan  for  the  same  months,  based  on  the  births 
of  the  preceding  twelve  months,  were  52.5  per  thousand — almost  exactly  three 
times  as  many. 

If,  in  addition  to  the  deaths  among  babies  attending  only  one  clinic,  we  ex- 
clude everything  except  diarrheal  and  malnutrition  deaths,  we  shall  have  the 
startling  total  of  66  deaths  among  5287  babies,  or  12.5  per  thousand.  This  is, 
of  course,  putting  the  matter  in  its  most  favorable  light,  and  is  mentioned  only 
as  an  interesting  statement. 

It  is  of  interest  to  study  the  percentage  of  the  deaths  in  each  group  in  rela- 
tion to  the  number  of  clinics  attended: 


TABLE  55.— PERCENTAGE  OF  DEATHS  IN  RELATION  TO  DIAGNOSIS  AND  NUM- 
BER OF  CLINICS  ATTENDED 


1  Clinic 

2  Clinics 

3  Clinics 

4   OR  MORE 

Diarrheal 

36.7 
19.0 
41.2 
42.9 
44.4 

22.8 
14.3 
0.0 
21.4 
11.1 

12.7 
28.6 
17.6 

7.1 
3.7 

27.8 

Malnutrition 

38.1 

Respiratory 

41.2 

Contagious 

28  6 

All  others 

40  7 

36.7 

17.1 

13.3 

32.9 

THE  RESULTS  AT  THE  MILK  STATIONS 


83 


The  interval  elapsing  between  the  time  when  the  baby  passed  from  under 
the  observation  of  the  station  to  date  of  death  is  shown  by  the  following  table : 

TABLE  56— PERCENTAGE  OF  DEATHS  IN   RELATION  TO  NUMBER  OF  CLINICS 
AND  INTERVAL  BETWEEN  LAST  ATTENDANCE  AND  DATE  OF  DEATH 


Days  Elapsing 


One  clinic , 

More  than  one  clinic 
All  cases 


I-IO 

11-20 

21-30 

31-40 

41-S0 

si-60 

61-70 

71-80 

81-90 

50.0 

3L0 

10.3 

1.7 

3.4 

0.0 

0.0 

1.7 

1.7 

48.0 

24.0 

17.0 

2.0 

3.0 

4.0 

2.0 

0.0 

0.0 

48.7 

26.6 

14.6 

1.9 

3.2 

2.5 

1.3 

0.6 

0.6 

Total 


99.9% 
100.0% 
100.0% 


From  the  above  the  following  conclusions  seem  to  be  warranted : 

First:  That  milk  stations  did  have  a  distinct  influence  in  diminishing  the 
mortality  among  babies  in  the  districts  in  which  they  were  situated. 

Second:  That  the  milk  stations  did  not  indirectly  encourage  artificial  feed- 
ing— 32.4  per  cent,  of  all  babies  under  one  year  of  age  were  entirely  breast-fed 
throughout;  60.6  per  cent,  were  partly  breast-fed. 

Third:  That  home  modification,  even  among  the  very  poor  and  ignorant,  is 
possible. 

Fourth:  That  the  results,  as  shown  by  the  mortality  and  by  the  condition  of 
the  surviving  babies  at  the  end  of  the  period  of  demonstration,  prove  that  as 
good  results  can  be  obtained  as  when  already  modified  milk  is  distributed. 


CHAPTER  VI 

Campaigns  in  Other  Cities 

While  the  figures  that  have  been  given  for  New  York  prove  conclusively! 
that  there  was  a  greater  reduction  in  infant  mortality  in  1911  than  in  any  pre- 
vious year ;  that  the  weather  conditions  were  not  such  as  to  explain  this  low  mor-| 
tality,  especially  in  the  early  summer;  and  that  the  diminution  in  Manhattan  and] 
Brooklyn,  where  a  very  vigorous  campaign  was  carried  out,  exceeded  that  of  the  I 
rest  of  the  city,  the  question  arises,  Was  the  mortality  in  New  York  reduced  morej 
than  in  other  large  cities? 

With  this  question  to  answer,  a  careful  tabulation  of  mortality  statistics  has! 
been  made  for  the  nine  largest  cities  in  the  country  after  New  York.  Study  was] 
also  made  of  the  weather  conditions,  and,  as  far  as  data  could  be  secured  from  pub- 
lished records  and  articles,  and  in  many  cases  from  personal  letters  from  health! 
officers  and  lay  and  medical  workers  in  those  cities,  a  comparison  was  made  of  the] 
extent  and  efficiency  of  the  campaign  against  infant  mortality. 

It  must  be  admitted  tha',  m-^st  of  the  efforts  at  reducing  infant  mortality  in  I 
this  country  have  been  carried  on  spasmodically,  being  almost  always  confined 
entirely  to  the  hot  summer  months.  It  is,  therefore,  these  three  hot  months,; 
generally  July,  August,  and  September,  that  we  shall  discuss  most  fully,  although  i 
the  figures  for  the  entire  year  also  give  important  information  as  showing  the 
eflfects  of  the  educational  campaign  carried  on.  The  various  cities  will  be  dis-j 
cussed  in  the  order  of  their  population. 

CHICAGO 

The  details  of  the  mortality  under  one  year  of  age  in  Chicago  are  shown  ii 
Table  57. 

If  we  analyze  these  figures,  we  find  that  the  total  deaths  in  Chicago  undei 
one  year  rise  steadily  from  1906  to  1908,  and  that  the  percentage  of  total  deaths! 
at  all  ages  occurring  during  the  first  year  of  life  rises  from  21.05  in  1906  to  22.67  inj 
1908.  In  1909  there  was  a  diminution  of  504  in  the  infant  deaths  for  the  yearj 
the  proportion  of  total  deaths  being  20.4.  In  1910  the  total  rose  almost  to  the! 
figure  of  1908,  but  the  percentage  of  the  total  mortality  remained  about  the  same. I 
In  1911  the  gross  total  reached  the  lowest  figure  since  1906,  although  it  was  onlyj 
75  below  1909. 

A  similar  condition  is  noted  in  the  deaths  occurring  during  the  three  summer 
months.     Again  1909  was  a  low  year,  1911  being  60  less  than  1909,  and  the  pro-j 
portion  of  the  year's  deaths  under  one  year  of  age  occurring  during  these  monthsl 
is  smaller  than  in  any  of  the  five  preceding  years.     The  percentage  of  total  deaths] 

84 


AROUSING  GENERAL  INTEREST  IN 


Exhibit  17 
Important  Facts  Brought  to  the  Attention  of 


THE  PROBLEM  OF  SAVING  BABIES 


Exhibit   17 
Mayors.  Health  Officers,  and  Civic  Organizations 


CAMPAIGNS  IN  OTHER  CITIES 


85 


at  all  ages  is  in  excess  of  1910,  but  less  than  any  of  the  other  four  years.  The 
Assistant  Registrar  of  Vital  Statistics  of  Chicago  states  that  about  one-third  of 
the  births  are  reported,  thanks  to  an  inefficient  ordinance,  so  that  infant  mor- 
tality rates  cannot  be  compared. 

TABLE  57.— MORTALITY  UNDER  ONE  YEAR  IN  CHICAGO 


January 

February 

March 

April 

May 

June 

July 

August 

September 

October 

November 

December 

Year 

Per  cent,  total  mortality 

July,  August,  and  September  .  . 
Per  cent,  year's  infant  mortality 
Per  cent,  of  total  deaths 


1906 

1907 

1908 

1909 

1910 

484 

568 

606 

588 

521 

454 

579 

698 

537 

497 

504 

611 

627 

557 

663 

494 

546 

547 

480 

524 

497 

536 

466 

490 

526 

344 

404 

389 

407 

478 

585 

487 

671 

435 

811 

749 

967 

863 

830 

758 

589 

676 

620 

699 

640 

480 

457 

525 

510 

504 

414 

390 

425 

399 

445 

520 

478 

451 

452 

474 

6114 

6699 

6888 

6384 

6841 

21.05 

20.81 

22.67 

20.40 

20.58 

1923 

2130 

2154 

1964 

2209 

31.45 

31.79 

31.27 

30.76 

32.29 

26.64 

27.81 

29.23 

26.13 

23.82 

Average 
FrvE  Years 


553 
553 
592 
518 
503 
404 
597 
833 
644 
495 
414 
475 


6581 

21.08 


2074 

31.52 
27.55 


1911 


576 
506 
543 
495 
540 
393 
614 
739 
551 
434 
421 
497 


6309 
19.31 


1904 
30.18 
24.69 


For  the  year  1911,  then,  in  relation  to  1910,  there  was  a  reduction  of  7.7  per 
cent,  of  actual  deaths  and  a  reduction  of  5.8  per  cent,  in  the  percentage  of  total 
deaths.  Of  deaths  for  July,  August,  and  September,  there  was  a  reduction  of 
13.8  per  cent,  in  actual  deaths,  but  an  increase  of  Z.Z  per  cent,  in  the  proportion 
of  total  deaths.  The  proportion  of  the  infant  mortality  for  the  year  occurring 
during  the  summer  months  is  less  by  6.5  per  cent. 

If,  now,  we  estimate  what  the  mortality  would  have  been  in  the  years  follow- 
ing 1906  if  the  infant  deaths  had  increased  at  the  same  rate  as  the  population 
(2.87  per  cent,  yearly),  and  then  compare  the  actual  mortality  in  these  years, 
we  find  the  conditions  which  are  set  forth  in  the  following  table : 

TABLE  58.— MORTALITY  WHICH  SHOULD   HAVE  OCCURRED  ON   BASIS  OF  1906 

FIGURES,  ALLOWING  FOR  INCREASE  IN  POPULATION,  COMPARED  WITH 

ACTUAL  MORTALITY,  IN  CHICAGO 


1907 

1908 

1909 

1910 

1911 

Estimated  mortality 

Actual  mortality 

6289 

6699 

+410 

6464 

6888 

+424 

6640 

6384 

—256 

6815 
6841 
+26 

6991 
6309 

Difference 

—682 

Percentage  difference 

+6.5% 

+6.5% 

-3.8% 

+0.3% 

—10.1% 

86 


INFANT  MORTALITY  AND  MILK  STATIONS 


The  deaths  in  each  year  from  1907  on  were  in  excess  of  this  estimated  rate 
by  from  0.3  to  6.5  per  cent.,  except  in  1909,  when  they  were  3.8  per  cent,  below 
the  estimated  figure.  In  1911  there  was  nearly  three  times  as  great  a  reduction 
from  the  estimate  as  in  1909. 

The  proportion  of  deaths  occurring  during  the  third  trimester  is  the  lowest 
of  any  of  the  cities  considered  except  Manhattan  and  Buffalo.  It  may  be  of 
interest  to  tabulate  these  figures  here  for  reference. 


TABLE  59.— DEATHS  UNDER  ONE  YEAR  BY  TRIMESTERS,  CHICAGO 

1906 

1907 

1908 

1909 

1910 

Average 
1906-10 

1911 

First  quarter:  Actual 

1442 
23.6 
1335 
21.8 
1923 
31.5 
1414 
23.1 

1758 
26.2 
1486 
22.2 
2130 
31.8 
1325 
19.8 

1931 
28.0 
1402 
20.4 
2154 
31.3 
1401 
20.3 

1682 
26.3 
1377 
21.6 
1964 
30.8 
1361 
21.3 

1681 
24.6 
1528 
22.3 
2209 
32.3 
1423 
20.8 

1698 
25.8 
1425 
21.7 
2074 
31.5 
1384 
21.0 

1625 

Per  cent,  of  year's  mortality  .  . 
Second  quarter:  Actual 

Per  cent,  of  year's  mortality  .  . 
Third  quarter:  Actual 

25.8 
1428 
22.6 
1904 

Per  cent,  of  year's  mortality  .  . 

Fourth  quarter:  Actual 

Per  cent,  of  year's  mortality  .  . 

30.2 

1352 
21.4 

Weather  Conditions 

The  weather  conditions  in  Chicago  during  the  last  three  years  may  be  com- 
pared in  the  following  tables : 


TABLE  60.— WEATHER  CONDITIONS:  NUMBER  OF  DAYS  MAXIMUM  AND  MEAN 

TEMPERATURES  REACHED  OR  EXCEEDED  CERTAIN  FIGURES,  CHICAGO* 

1909 

Maximum  Temperature  was —  Mean  Temperature  was — 

95°  or  -H  90°  or  +  85°  or  +  85°  or  +          80°  or  + 

June 0  0  5  0                   1 

July 0  3  11  0                  2 

August 0  2  8  0                  4 

September 0  0  2  0                   1 

0  5  26  0                  8 
1910 

June 0  3  7  0                   6 

July 2  6  13  0                 9 

August 0  0  10  .04 

September 0  0  0  0                  0 

2  9  30  0                19 
1911 

June 3  6  9  2                   5 

July 5  9  15  6               10 

August 0  4  7  0                  4 

September 0  0  1  0                  0 

8  19  32  8                19 

*  Monthly  Meteorological  Summary,  Local  Weather  Bureau,  Chicago,  and  Monthly  Weather 
Review,  Washington. 


CAMPAIGNS  IN  OTHER  CITIES 


87 


TABLE  61.— MONTHLY  MEAN   TEMPERATURE,  PRECIPITATION,  AND   NUMBER 

OF  RAINY  DAYS,  CHICAGO* 


Average  39  Years 

1909 

1910 

1911 

June 

Mean 

66.4° 
3.56  in. 

67° 
5.09  in. 

68° 
0.91  in. 

72° 

Rainfall 

2.54  in. 

Rainy  days 

13+5 

4+1 

10+2 

July 

Mean 

73° 
3.57 

72° 
1.77 

76° 
1.79 

76° 

Rainfall 

2.65 

Rainy  days 

8+6 

8+5 

11+2 

August 

Mean 

71° 
3.10 

75° 
6.20 

73° 
3.08 

72° 

Rainfall 

3.72 

Rainy  days 

10+3 

6+5 

12+2 

September 

Mean 

65° 

64° 

65° 

67° 

Rainfall 

3.07 

3.60 

3.90 

4.03 

Rainy  days 

8  +  1 

9+4 

16+4 

Total 

Mean 

68.6° 
13.30 

69.5° 
16.66 

70.5° 
9.68 

71.7° 

Rainfall 

12.94 

Rainy  days 

39+15 

27  +  15 

49  +  10 

Note. — ^Two  figures  are  given  for  number  of  rainy  days — the  first,  in  front  of  the  plus  sign, 
I  is  the  number  of  days  precipitation  was  0.01  inch  or  more;  the  second,  after  the  plus  sign,  is 
!  number  of  days  there  was  a  trace  of  precipitation,  but  less  than  0.01  inch. 

If  we  study  these  tables,  we  find  that  the  maximum  temperature  for  the 
four  months,  taken  as  a  whole,  reached  85°,  90°,  and  95°  on  more  days  than  in 
either  1909  and  1910.  The  thermometer  never  reached  95°  in  1909,  and  on  only 
five  days  did  it  reach  90°.  In  1910  it  registered  95°  or  +  on  only  two  days,  and 
90°  on  only  nine  days,  as  against  eight  and  nineteen  days  respectively  in  1911. 
Similarly,  the  mean  temperature  never  reached  85°  in  either  1909  or  1910,  while 
it  did  so  on  eight  days  in  1911. 

Only  the  month  of  August  fell  below  1909  and  1910  as  to  mean  temperature 
for  the  whole  month.  The  average  for  four  months  was  decidedly  higher  than 
either  year,  and  3°  higher  than  the  average  for  thirty-nine  years.  In  each  month, 
however,  the  total  rainfall  was  higher  than  in  1910,  though  it  was  above  the 
thirty-nine-year  average  only  in  August  and  September.  In  July  and  Sep- 
tember it  exceeded  the  figures  for  1909.  For  the  four  months  the  rainfall  was 
well  above  that  of  1910  and  well  below  that  of  1909.  In  the  number  of  rainy 
days  1911  is  largely  In  excess  of  either  year. 

The  month  of  July  Is  particularly  interesting.  The  mean  temperature  for 
the  month  was  4°  higher  in  1911  than  in  1909,  and  the  deaths  were  170  more  than 
in  1909.  There  was  the  same  mean  for  1910  and  1911,  and  the  deaths  in  1911  were 
197  less  than  in  1910.  Also  the  deaths  in  1910  were  376  more  (86  per  cent.)  than 
in  1909,  as  against  170  more  (39  per  cent.)  in  1911. 

In  1910  and  1911  August  was  2°  and  3°  below  1909,  and  the  deaths  were  72 


*  Monthly   Meteorological    Summary,   Local   Weather    Bureau, 
Weather  Review,  Washington. 


Chicago,   and    Monthly 


88  INFANT  MORTALITY  AND  MILK  STATIONS 

and  91  respectively  below  those  of  1909.     In  September,  on  the  other  hand, 

1910  was  1°  and  1911  was  3°  above  1909,  and  yet  the  deaths  were  respectively 
59  and  148  below  those  of  1909. 

In  July  the  rainfall  was  practically  the  same  for  1909  and  1910,  and  0.86  inch 
more  in  1911.     August  showed  less  rainfall  by  3.12  and  2.48  inches  in  1910  and 

1911  than  in  1909,  in  both  of  the  latter  years  the  deaths  being  less.     In  September 
the  rainfall  was  nearly  the  same,  +0.30  inch  in  1910  and  +0.43  inch  in  1911. 


The  Campaign 

For  a  number  of  years  Chicago  had  been  getting  ready  for  an  organized  effort 
for  combating  infant  mortality.  The  United  Charities,  then  consisting  of  two 
separate  organizations,  attempted  to  get  mothers  and  babies  out  of  the  city,  to 
care  for  the  sick  babies,  and  to  educate  the  mothers  in  the  city  itself  by  means  of 
public  tents,  in  charge  of  a  trained  nurse  and  visited  by  a  physician.  The  Chil- 
dren's Hospital  Society  established  a  Milk  Commission  to  provide  a  modified  and 
pasteurized  milk  for  babies  at  a  reasonable  price.  Milk  was  dispensed  already 
modified  to  set  formulae. 

In  1908  the  Health  Department  first  entered  the  field,  putting  100  physicians 
at  work  visiting  from  house  to  house,  instructing  the  mothers,  during  July  and 
August.  The  work  was  not  organized,  and  very  little  came  of  it;  but  a  more 
comprehensive  plan  was  worked  out  during  the  ensuing  winter. 

In  1909  the  United  Charities,  the  Health  Department,  and  the  Visiting 
Nurses'  Association  cooperated.  The  Health  Department  mapped  out  the  areas 
of  the  highest  death-rate,  furnished  20  nurses  and  14  doctors,  and  spent  $10,000 
on  the  campaign.  The  United  Charities  furnished  nurses,  tents,  and  workers. 
The  Visiting  Nurses'  Association  supervised  the  tents,  furnished  nurses  in  the 
tents,  and  worked  in  the  field. 

The  general  plan  was  a  house-to-house  canvass  by  nurses  in  the  most  crowded 
and  unsanitary  districts.  Wherever  a  small  child  was  found,  instruction  in 
feeding  and  care  was  given.  At  first  the  Health  Department  confined  its  activi- 
ties to  locating  and  referring  cases,  the  actual  care  of  the  sick  babies  being  turned 
over  to  the  Visiting  Nurses'  Association,  the  settlements,  and  the  United  Chari- 
ties. During  July  so  much  work  had  to  be  done  that  the  Health  Department  had 
to  take  up  part  of  the  work  of  caring  for  the  sick.  Careful  records  were  kept  of 
all  the  cases,  and  information  was  acquired  which  was  tabulated  during  the  follow- 
ing months  for  use  in  the  campaign  of  the  next  year. 

It  will  be  noted  that  1909  was  the  first  year  with  a  lowered  mortality  since 
1906.     The  percentage  of  the  total  mortality  was  also  low. 

Armed  with  the  information  obtained  in  1909,  the  work  was  more  active  in 
1910  and  better  organized.  The  activities  of  the  Health  Department  were  con- 
fined to  one  entire  ward  and  parts  of  three  others,  as  far  as  house-to-house  visiting 
was  concerned;  and  in  13  other  wards  they  visited  the  homes  of  every  baby  that 
could  be  discovered  from  the  records  of  the  United  Charities  or  the  County  Clerk's 
register  of  births.     Ten  public  tents  were  located  in  centers  having  the  highest 


(lARBAGE   AND  WaSTE  FORTY-EIGHT   HoURS    IN  THE  STREET;    OnE  OF  THE  HANDICAPS 

OF  A  Summer  Baby-saving  Campaign 


CAMPAIGNS  IN  OTHER  CITIES  89 

death-rates.  These  were  maintained  by  the  United  Charities.  Dr.  CaroHne 
Hedger  spent  her  whole  time  in  the  work.  An  Infant  Welfare  Society  was 
formed,  consisting  of  representatives  of  all  the  various  charities  in  Chicago. 

During  the  summer  the  mothers  of  23,984  babies  were  instructed.  Ice 
tickets  were  distributed,  and  relief  was  provided  through  the  United  Charities, 
Jewish  Aid,  etc.  The  nurses  were  on  the  lookout  for  violations  of  the  Sanitary 
Code,  and  500  complaints  were  made. 

The  Civic  Federation  placarded  the  city  fences  and  walls  with  a  telling  poster, 
"Don't  Kill  your  Baby!" — with  information  how  not  to,  and  this  was  most 
effective.  The  well-known  Bulletins  of  the  Health  Department  featured  the 
campaign,  and  its  "Health  Grams  "and  striking  cartoons  went  far  and  wide. 

In  1911  there  was  much  greater  cooperation  among  the  nurses  of  the  De- 
partment and  other  organizations.  The  work  of  the  Health  Department  be- 
came more  definite,  and  in  every  way  the  campaign  was  more  efhcient. 

The  Infant  Welfare  Society  maintained  10  milk  stations,  open  all  the  year, 
each  in  charge  of  a  nurse.  Volunteer  physicians  carried  on  the  consultations, 
of  which  806  were  held.  Two  thousand  one  hundred  and  twenty-nine  babies 
attended  these  conferences.  Home  modification  was  taught  "when  possible"; 
when  impossible,  modified  milk  was  dispensed.  Six  hundred  and  twenty  mothers 
were  taught.     Certified  milk  only  was  used.* 

It  will  be  noted  that  there  was  an  increase  in  mortality  in  1910  over  1909 
nearly  up  to  the  figures  of  1908,  although  this  is  only  0.3  per  cent,  greater  than 
the  mortality  estimated  on  the  1906  figures.  The  work  of  the  nurses,  while  more 
efficient,  was  not  nearly  so  wide-spread  as  in  1909.  In  1911,  due  to  increased  ex- 
perience and  better  cooperation,  a  great  diminution  was  again  obtained,  especially 
marked  during  the  summer  months,  in  spite  of  unfavorable  weather  conditions. 
Dr.  Hedger,  who  has  had  charge  of  the  work  in  large  part  during  the  last  three 
years,  says:  "The  campaign  should  be  a  year-long  affair;  a  few  weeks  of  instruc- 
tion in  the  summer  is  not  sufificient.  It  must  be  line  upon  line  and  precept  upon  pre- 
cept, year  in  and  year  out."t  Chicago  realizes  the  importance  of  continuous 
instruction  to  obtain  permanent  results,  and  not  an  ineffectual,  short  campaign. 

Since  1910  Chicago  has  been  attempting  to  enforce  the  laws  pertaining  to  a 
safe  milk  supply.  Seventy-five  per  cent,  of  the  city's  milk  is  pasteurized. 
All  the  rest  must  be  from  tuberculin-tested  herds.  As  thorough  an  inspection  of 
pasteurization  plants  is  carried  out  as  available  funds  will  permit.  There  is 
also  inspection  of  dealers  and  depots,  platform  inspection,  and  a  certain  amount 
of  country  farm,  creamery,  and  bottling  plant  inspection.  It  is  interesting  to  note 
that,  excepting  that  provided  to  restaurants,  95  per  cent,  of  the  city's  milk  is 
bottled. 

*  The  above  facts  are  obtained  from  the  report  of  the  Department  of  Health  of  the  City  of 
Chicago  for  the  years  1907-1910.  and  from  personal  letters.  In  1912  we  are  informed  that  prac- 
tically all  modification  is  done  at  the  home.  Through  cooperation  with  certain  milk  dealers 
certified  milk  is  delivered  direct  to  the  homes  at  10  cents  a  quart. 

t  Report  of  the  Campaign  Against  Summer  Diarrhea,  Chicago,  1909,  etc. 


90 


INFANT  MORTALITY  AND  MILK  STATIONS 


PHILADELPHIA 

We  have  been  unable  to  obtain  reports  or  records  of  infant  mortality  inij 
Philadelphia  by  months  prior  to  1909.  The  following  table  gives  the  figures  as 
far  as  obtainable:* 

TABLE  62— MORTALITY  UNDER  ONE  YEAR,  PHILADELPHIA 


1906 

1907 

1908 

1909 

1910 

1911 

January' 

387 
438 
433 
330 
289 
396 
659 
490 
496 
364 
238 
350 

398 

404 
497 
349 
313 
540 
799 
552 
426 
315 
284 
355 

286 

February' 

■  ' 

289 

March 

427 

April 

332 

May 

344 

June 

401 

Tulv 

587 

August . 

September 

556 
394 

October 

313 

November 

December 

330 

357 

Total 

Per  cent,  total  mortality 

5781 
31.1 

5508 
30.0 

5291 
30.1 

4870 
19.4 

5232 
19.3 

4616 
17.6 

July,  August,  and  September 

Per  cent,  year's  infant  mortality .  .  . 
Per  cent,  total  mortality 

1645 
33.7 
38.4 

1777 
33.9 
37.9 

1537 
33.3 
35.0 

Births 

34,771 
166.3 

35,142 
136.7 

36,641 
144.1 

37,540 
139.7 

38,676 
135.3 

41,000t 

Intant  Mortality 

113.5t 

In  1911,  therefore,  Philadelphia  had  less  deaths  by  254  than  in  1909,  the 
low  record  of  the  five-year  period  1906-1910;    1165  less  than  in  1906,  the  high 

year;  and  616  less  than  in  1910.  The  proportion  of  the  total  mortality  for  the 
year  is  17.6  per  cent.,  a  fall  of  1.8  from  1909;   3.5  from  1906;  and  1.7  from  1910. 

The  summer  infant  mortality  was  practically  the  same  proportion  of  the 
year's  infant  mortality  as  in  1909  and  1910;  but  of  the  total  deaths  it  was  3.4 
per  cent,  and  2.9  per  cent,  lower. 

The  infant  mortality  rate  also  shows  a  marked  fall,  although  it  is  only  estimated. 
There  is  a  reduction  of  22.8  and  17.2  per  thousand  from  1909  and  1910  respectively. 

In  tabular  form  this  appears  as  follows: 

TABLE  63.— DIFFERENCE   BETWEEN   MORTALITY  UNDER  ONE  YEAR   IN   1911 

AND  OTHER  YEARS 


Year's  mortality 

Per  cent,  total  mortality 
July,  August,  and  September 

Per  cent,  total  year 

Per  cent,  total  mortality 


Percentage    Difference 


1909 

-  5.2 

-  9.3 

-  6.5 

-  1.4 
-11.9 


1910 

—11.7 

—  8.8 
—13.5 

—  2.0 
—10.3 


•  From  figures  supplied  by  Dr.  S.  W.  Newmeyer,  Philadelphia. 


t  Estimated. 


CAIMPAIGXS  IX  OTHER  CITIES 


91 


In  1903  there  were  4597  deaths  under  one  year  of  age  in  Philadelphia,  which 
was  17.7  per  cent,  of  the  total  mortality.  This  is  the  low  record  year  of  the  decade 
in  both  respects.  The  following  table  shows  the  deaths  which  would  have  oc- 
curred had  they  increased  in  proportion  to  the  population  increase,  and  the  actual 
and  percentage  differences  from  these  figures: 

TABLE  64.— MORTALITY  UNDER  ONE  YEAR,  WHICH  SHOULD  HAVE  OCCURRED 

IN  DIFFERENT  YEARS,  BASED  ON  1903  FIGURES,  COMPARED  WITH 

ACTUAL  MORTALITY,  PHILADELPHIA 


1906 

1907 

1908 

1909 

1910 

1911 

Estimated  deaths 

4868 

5781 

+  913 

+18.7 

4959 

5508 

+  549 

+11.0 

5049 

5291 

+242 

+  4.7 

5140 

4870 

—270 

—  5.3 

5230 

5232 

+     2 

+  0.0 

5321 

Actual  deaths 

4616 

Difference 

Percentage  difference 

—  705 
—13.3 

There  is,  therefore,  a  very  great  reduction  in  1911  from  every  point  of  view. 

Weather  Coxditioxs 
The  weather  conditions  during  the  last  three  years  are  set  forth  in  the  follow- 
ing tables : 

TABLE  65.— NUMBER  OF  DAYS  ON  WHICH  M.AXIMUM  AND  MEAN  TEMPERA- 
TURES   REACHED    CERTAIN    FIGURES,    PHILADELPHIA* 


MAXniuii  Temperature 

Me.'vx  Temperature 

95°  or  + 

90°  or  + 

8s°  or  + 

85°  or  + 

80°  or  + 

1909 

June 

July 

0 
1 
1 
0 

2 

8 
5 
3 
0 

16 

10 

17 

13 

0 

40 

1 
1 
1 
0 

3 

8 
8 

August 

September  .  .  . 

3 
0 

19 

1910 

June 

1 
0 
0 
0 

1 

5 

10 
0 

1 

15 

8 
19 

5 
3 

35 

1 
1 
0 
0 

2 

5 

July 

August 

September   .  .  . 

17 
0 
2 

24 

1911 

June 

0 
5 
0 
0 

5 

2 

10 
3 
0 

IS 

9 
19 
13 

2 

43 

0 
6 
0 
0 

6 

3 

July 

12 

August 

September   .  . . 

5 
0 

20 

*  Monthly  Meteorological  Summary,  Philadelphia;   and  Monthly  Weather  Review,  Wash- 
ington, D.  C. 


92  INFANT  MORTALITY  AND  MILK  STATIONS 

TABLE  66.— MONTHLY    MEAN   TEMPERATURE,    RAINFALL,   AND    NUMBER    OF; 

RAINY  DAYS,  PHILADELPHIA* 


Normal 

1909 

1910 

1911 

JVNE 

Mean  temperature 
Rainfall 

71.2° 
3.30  in. 

75.8° 
4.33  in. 

73.8° 
4.61  in. 

67.4° 
3.38  in. 

72.05° 
15.62  in. 

72.4° 
2.26  in. 
13 

75.3° 
2.19  in. 

4+4 

73.0° 
1.95  in. 

4+2 

67.2° 
3.55  in. 
8 

71.9° 
9.95  in. 
29+6 

69.6° 
5.40  in. 
14 

78.2° 
1.84  in. 

5 

73.2° 
5.70  in. 
11 

70.0° 
3.05  in. 
5 

72.75° 
15.99  in. 
35 

71.6° 
5.10  in. 

Rainy  days 

July 

Mean  temperature 
Rainfall 

14+3 

78.5° 
4.19  in. 

Rainy  day^ 

August 

Mean  temperature 
Rainfall 

9+2 

74.5° 
12.10  in. 

Rainy  days 

September 

Mean  temperature 

Rainfall 

Rainy  days 

Totals 

Mean  temperature 

Rainfall 

Rainy  days 

14+3 

68.6° 

2.52  in. 
7+6 

73.3° 
23.91  in. 

44  +  14 

Note. — Two  figures  are  given  above  for  number  of  rainy  days — the  first,  in  front  of  the 
plus  sign,  is  the  number  of  days  precipitation  was  0.01  inch  or  more;  the  second,  after  the  plus 
sign,  is  number  of  days  there  was  '■  Lisce  of  precipitation,  but  less  than  0.01  inch. 

Except  for  extremely  hot  weather,  that  is,  the  number  of  days  when  very 
high  temperatures  were  reached,  there  was  very  Httle  difference  in  the  temperature 
records  for  the  three  years. 

The  mean  temperatures  for  the  month  show  1911  above  the  normal  in  all 
four  months,  especially  in  July;  1910  was  lower  than  1911  in  each  month  except 
September,  although  there  was  only  0.3°  difference  in  July.  July  and  September 
were  above  the  normal;  1909  was  below  the  normal  in  all  months  except  June, 
although  very  slightly.  In  1909  the  heat  was  more  uniformly  distributed 
throughout  the  summer. 

In  1911  rainfall  for  the  month  and  the  number  of  rainy  days  were  consider- 
ably in  excess  of  1910,  especially  in  July  and  August.  June  and  September,  1910, 
had  a  little  more  rain. 

During  June,  July,  and  August  temperature  conditions  may  be  said  to  have 
been  distinctly  less  favorable  to  a  low  infant  mortality  than  in  1909  and  1910- 
In  respect  to  rainfall  and  its  distribution  during  the  same  period,  conditions  were 
more  favorable. 


The  Campaign 

Before  1909  there  was  very  little  effort  made  toward  the  reduction  of  infant 

mortality  outside   the  ordinary  work  of   the  various  charitable  organizations. 

The  Modified  Milk  Society  was  about  the  only  special  agency  at  work.     It  pro- 

*  Monthly  Meteorological  Summary,  Philadelphia;  and  Monthly  Weather  Review,  Washing- 
ton, D.  C. 


Any  Place  Will  Do  for  a  Milk  Station 


I 


I 


CAMPAIGNS  IN  OTHER  CITIES  93 

ided  milk  modified  at  a  central  laboratory  and  distributed  to  infants  from  several 
(oints  in  the  most  congested  sections  of  the  city. 

In  1909  Dr.  Neff,  Director  of  the  Department  of  Public  Health  and  Charities, 
)rought  about  a  revision  of  the  milk  ordinances  after  considerable  publicity  had 
»een  given  to  the  statement  that  12  per  cent,  of  the  milk  furnished  the  city  was 
rom  cattle  infected  with  tuberculosis. 

A  conference  was  held  early  in  the  summer,  at  which  plans  were  considered 
or  reducing  infant  mortality.  As  a  result,  the  Modified  Milk  Society,  various 
ettlements,  and  a  number  of  women's  clubs  conducted  work  along  independent 
ines.  The  Health  Department  placed  its  medical  inspectors  in  the  most  con- 
jested  parts  of  the  city  to  canvass  for  sick  babies  and  to  instruct  mothers  in  their 
are.  Milk  dealers  were  provided  with  bags  upon  which  were  printed  simple 
lirections  as  to  the  care  of  milk  and  feeding  of  the  baby.  Bottled  milk  was  sold 
n  these  bags. 

In  1910  a  conference  was  called  by  the  Mayor.  This  was  attended  by  rep- 
■esentatives  of  some  200  agencies,  the  object  being  to  bring  about  a  better  work- 
ng  relation  between  the  various  organizations  engaged  in  summer  work  for 
nothers  and  children.  As  a  result  of  this  conference  a  Bureau  of  Registration 
md  Information  was  established  at  the  City  Hall.  A  directory  was  published 
md  distributed,  giving  the  names  of  agencies  and  the  kind  of  service  each  was 
prepared  to  render. 

The  Modified  Milk  Society  established  10  distributing  stations  and  later 
jpened  8  more.  The  City  Council  appropriated  funds  to  maintain  a  corps  of  8 
lurses,  and,  by  utilizing  the  medical  inspectors  and  district  physicians,  a  tem- 
Dorary  Division  of  Child  Hygiene  was  established,  with  Dr.  S.  W.  Newmayer  in 
:harge.  This  division  began  intensive  work  in  June  in  four  of  the  most  congested 
wards.  Other  organizations  assisted  by  furnishing  nurses  who  reported  daily  to 
the  Health  Department  and  worked  with  their  nurses.  Two  nurses  each  were 
provided  by  the  Bureau  of  Municipal  Research,  the  Visiting  Nurses'  Society, 
Starr  Centre,  and  the  Light  House,  and  one  each  by  the  Phipps  Institute  and  the 
Baby  Alliance. 

Previous  to  the  closing  of  the  schools  in  the  four  wards  selected,  demonstra- 
tions were  given  to  girls  in  the  grammar  grades  on  the  care  of  babies.  This  work 
was  done  by  the  medical  inspectors  and  school  nurses  through  the  cooperation  of 
the  school  authorities.  A  house-to-house  canvass  was  carried  on  in  the  district 
by  the  Health  Department  nurses  to  instruct  mothers  in  their  homes. 

At  the  central  office  a  careful  system  of  record  keeping  for  each  case  was  in- 
stalled. Day  and  night  telephone  service  was  established  for  receiving  requests 
for  aid  in  emergency  cases.  The  Police  and  Fire  Departments  cooperated  by 
instructing  all  police  stations  and  fire  houses  to  forward,  by  telephone,  any  re- 
quest for  medical  or  nursing  aid.  A  large  number  of  bulletins,  posters,  and  cir- 
culars were  distributed,  chiefly  through  the  police  department. 

The  Visiting  Nurses'  Society  assumed  supervision  and  care  of  sick  babies. 
Piers  were  utilized  for  receiving  and  caring  for  babies  and  mothers.     Special 


94  INFANT  MORTALITY  AND  MILK  STATIONS 

hospital  facilities  were  made  available,  the  hospital  at  Redbank,  N.  J.,  cooperat- 
ing by  receiving  babies. 

Free  ice  was  distributed,  midwives  were  checked  up,  and  several  baby  farms  j 
were  closed. 

The  Philadelphia  Association  of  Retail  Druggists  passed  resolutions  indors- 
ing the  stand  taken  by  the  Health  Department  in  regard  to  soothing  syrup  and 
comforters,  and  discouraging  their  sale  by  its  members. 

There  was  a  reduction  of  40  per  cent,  in  the  deaths  under  two  years  in  the 
four  wards  where  the  work  was  concentrated.  In  the  city  itself,  during  the  three 
summer  months,  there  was  an  increase  of  132  deaths  over  those  in  1909,  though 
the  proportion  of  the  total  deaths  which  occurred  under  one  year  fell  0.5  per  cent. 

In  1911  a  still  more  vigorous  campaign  was  waged.  A  "Milk  Show"  was 
held  May  20th-27th,  which  was  attended  by  110,681  people.  Considerable  in- 
terest in  the  problem  was  aroused. 

The  City  Council  voted  $5,000  for  the  summer  work,  and  the  nursing  stafif 
was  increased.  The  work  was  carried  on  in  four  wards.  Sick  babies  were  cared 
for  at  the  recreation  piers  by  night  as  well  as  by  day. 

The  Mayor  appointed  a  strong  commission  to  investigate  and  report  upon 
the  whole  subject  of  the  milk  supply.  The  refrigeration  of  milk  in  transit  was 
required  for  the  first  time. 

The  experience  of  previous  years  bore  fruit  in  a  better  organized  campaign 
and  a  great  reduction  in  the  summer  mortality,  both  from  1910  and  1909  figures. 
In  the  four  wards  where  the  nurses  were  working  there  was  a  reduction  of  11.3 
per  cent,  in  all  deaths  under  one  year  from  the  1910  figures,  and  of  34.6  per  cent, 
in  diarrheal  deaths  under  two  years. 


CAMPAIGNS  IN  OTHER  CITIES 


95 


ST.  LOUIS 

Table  67  shows  the  infant  mortality  statistics  for  St.  Louis  for  the  five-year 
jeriod  1906-1910,  the  average  for  the  five  years,  and  the  figures  for  1911. 

TABLE  67.— MORTALITY  UNDER  ONE  YEAR,  ST.  LOUIS 


1906 

1907 

1908 

1909 

1910 

Average 

Five 

Years 

1911 

' anuary 

■"ebruary 

vlarch 

^pril 

\jla.y 

143 
112 
122 
132 
100 
U1 
264 
204 
195 
132 
125 
138 

127 
121 
144 
121 
76 
122 
315 
181 
160 
107 
112 
129 

146 
102 
117 
120 
116 
189 
229 
204 
115 
125 
148 
123 

136 
151 
128 
116 
121 
151 
229 
196 
137 
127 
128 
103 

129 
139 
146 
93 
115 
177 
216 
201 
149 
133 
105 
104 

136 
135 
131 
116 
105 
157 
350 
197 
151 
134 
133 
119 

166 

107 

102 

92 

96 

une 

ulv 

160 

228 

\.ugust 

September 

170 
141 

Dctober 

*Jovember 

111 
109 

December 

97 

^EAR 

1814 
17.91 

1715 
16.50 

1734 
17.73 

1723 
16.04 

1707 
15.67 

1738 

16.74 

1579 

Percentage  total  mortality 

14.55 

f  une— September 

810 

36.5 

34.3 

778 

38.3 

23.4 

737 

31.6 

33.8 

713 

33.6 

30.8 

113.3 

743 

33.3 

31.4 

112.1 

756 

34.5 
22.7 

699 

Percentage  deaths  all  ages 

34.1 
30.5 

101.6 

It  will  be  seen  that  during  the  four  years  1907-1910  there  was  very  slight 
v^ariation  in  the  total  year's  mortality  under  one  year  of  age.  The  year  1906  was 
a  high  one,  the  low  year  being  1910.  In  comparing  the  proportion  of  total  deaths 
which  occurred  under  one  year  of  age  there  is  no  very  great  difference  between 
the  first  and  third  years  of  the  five-year  period.  In  1909  and  1910,  however, 
there  is  a  distinct  fall.  The  year  1911  gives  the  lowest  gross  total  for  the  year, 
as  well  as  the  lowest  percentage  of  all  deaths.  In  comparing  the  summer  mor- 
tality it  will  be  noticed  that  the  four  months,  June,  July,  August,  and  September, 
are  given  instead  of  July,  August,  and  September.  St.  Louis  mortality  begins 
to  increase  earlier  than  the  more  northern  cities,  and  in  many  years  June  is  much 
higher  than  September.  If  we  compare  these  figures,  we  will  see  that  there  has 
been  a  slight  general  decrease  since  1906,  and  that  this  decrease  was  greater  in 
1911  than  in  any  other  year. 

*  From  figures  provided  by  Mrs.  Minnie  D.  Weiss. 


96 


INFANT  MORTALITY  AND  MILK  STATIONS 


The  following  table  shows  what  the  deaths  would  have  been  had  they  in- 
creased from  1907,  the  low  year  up  to  1910,  at  the  same  rate  as  the  population,! 
1.94  per  cent,  per  year. 

TABLE  68.— MORTALITY  UNDER  ONE  YEAR  WHICH  SHOULD  HAVE  OCCURRED, 
B\SED  ON   1907  FIGURES,  COMPARED  WITH  ACTUAL  MORTALITY, 

ST.  LOUIS 


Estimated  mortality . 
Actual  mortality .... 

Difference 

Percentage  difference . 


1908 


1748 

1734 

—  14 

—0.8 


1909 


1781 

1723 

—  58 

—3.2 


1910 


1814 

1707 

—107 

—  5.8 


1911 


1848 

1579 

—  269 

—14.5 


Yearly  rate  of  increase  in  population,  1.94  per  cent. 

Allowing  for  the  increase  in  population,  then,  there  has  been  a  steadily  de- 
creasing mortality  rate,  and  the  percentage  difference  from  the  estimate  has  been 
greater  each  year  up  to  and  including  1911. 

Weather  Conditions 
Comparing  the  weather  conditions  which  existed  in  St.  Louis  during  these 
years  we  find  the  facts  set  forth  in  the  following  tables : 

TABLE  69.— NUMBER  OF  DAYS  MAXIMUM  AND  MEAN  TEMPERATURE  REACHED 
OR  EXCEEDED  CERTAIN  FIGURES,  ST.  LOUIS* 


1909 


June 

July 

August.  .  . 
September 


1910 


June 

July 

August.  .  . 
September 


1911 


June 

July 

August .  .  . 
September 


Maximum  Temperature 


95°  or  + 


6 
2 
1 

17 


90°  or  + 


5 

6 

18 

2 

31 

7 
5 
5 
0 

17 

13 

13 

8 

5 

39 


85°  or  + 


14 
15 
27 


64 

14 

15 

13 

6 

48 

22 
21 
15 

15 

73 


Mean  Temperature 


85°  or  + 


5 
7 
3 
0 

15 


80°  or 


6 

9 

23 

1 

39 


11 
6 
1 

26 

15 

15 

11 

4 

45 


•  From  Monthly  Meteorological  Summary,  Local  Weather  Bureau,  St.  Louis,  and  Monthly 
Weather  Review,  Washington,  D.  C. 


After  a  Coxslltatiox — Future  Mothers  are  Being  Taught 


CAMPAIGNS  IN  OTHER  CITIES 

TABLE  70.— MONTHLY  MEAN  TEMPERATURE,  PRECIPITATION, 

OF  RAINY  DAYS,  ST.  LOUIS* 

97 

AND  NUMBER 

Average,  Thirty- 
eight  Years 

1909 

1910 

1911 

Tune 

Mean 

75° 
4.49  in. 

79° 
3.63  in. 

78° 
2.48  in. 

70° 
2.89  in. 

75.5° 
13.49  in. 

75° 
2.63  in. 
10+5 

77° 
7.34  in. 
13+4 

81° 
0.66  in. 

4+3 

68° 

4.22  in. 
00  +  0 

75.2° 
14.85  in. 
00  +  0 

72° 
4.24  in. 
11+0 

77° 
4.21  in. 
14+0 

75° 
1.90  in. 

7+3 

70° 
6.09  in. 
10  +  2 

73.5° 
16.44  in. 

42+5 

79° 

Rain 

Rainy  days 

Tidy 

Mean 

1.34  in. 
8  +  1 

79° 

Rain 

0.64  in. 

Rainy  days 

iugust 

Mean 

5+5 
76° 

Rain 

3.51  in. 

Rainy  days 

September 

Mean 

11  +  1 

74° 

Rain 

7.09  in. 

Rainy  days 

Total 

j       Average  mean  . . 

Rain   

14+5 

77° 
12.58  in. 

Rainy  days 

38  +  12 

Nntf.. — Two  fi?i] 

res  are  e-iven  for  nu 

mber  of  rainv  da\ 

^s — the  first,  in  fro 

nt  of  the  dIus  sien. 

3  the  number  of  days  precipitation  was  0.01  inch  or  more;   the  second,  after  the  plus  sign,  is 
the  number  of  days  there  was  a  trace  of  precipitation,  but  less  than  0.01  inch. 


i  It  will  be  seen  that  June,  1911,  averaged  for  the  month  higher  than  either  of 
che  other  years  or  than  the  thirty-eight-year  average.     The  same  is  true  for  July. 

August,  on  the  contrary,  is  5°  below  1909  and  2°  below  the  mean,  but  August 
lad  some  very  hot  weather,  the  thermometer  registering  95°  on  two  days  and  the 
nean  for  the  day  being  85° -f  'on  three  days.  September  was  hot,  the  mean 
Deing  well  above  either  year  and  the  thirty-eight-year  average.  The  rainfall 
ilso  in  1911  was  very  scant  through  June  and  July,  but  above  the  average  for 
\ugust  and  September,  especially  in  the  latter  month.  Extremely  high  tempera- 
;ures  were  reached  during  the  four  summer  months  of  1911,  remained  high  for 
onger  periods,  and  the  hot  weather  was  continued  throughout  the  summer  more 
evenly  than  in  any  of  the  other  years  considered. 

In  spite  of  very  much  worse  conditions  in  June  and  July,  the  mortality  in 
fune  was  17  below  1910  and  9  above  1909.  In  July  it  was  1  below  1909  and 
12  above  1910. 

*  Monthly  Meteorological  Summary,  Local  Weather  Bureau,  St.  Louis,  and  Monthly  Weather 
leview,  Washington,  D.  C. 


98  INFANT  MORTALITY  AND  MILK  STATIONS 

The  Campaign 

In  1904  the  St.  Louis  Pure  Milk  Commission  was  incorporated  for  the  pur- 
pose of  distributing  modified  milk  to  poor  babies.  After  two  years  of  work  Dr. 
A.  S.  Bleyer  started  consultations  at  one  of  the  stations  of  the  Commission.  This 
work  was  founded  with  the  idea  of  instructing  mothers  in  the  care  of  their  babies, 
and  modified  milk  was  dispensed.  In  the  spring  of  1911  the  "Save  the  Babies" 
League  was  formed,  to  cooperate  with  existing  agencies  for  the  prevention  of 
sickness  and  death  among  the  babies  of  St.  Louis.  In  the  previous  summer  the 
Pure  Milk  Commission  had  carried  on  some  nursing  work,  but  was  financially 
unable  to  continue  it.  In  1911  the  Visiting  Nurses'  Association  had  one  nurse  in 
the  field.  The  object  of  this  League  was  the  maintenance  of  conferences  where 
mothers  were  advised  and  instructed  by  the  doctors  in  charge  in  the  care  and 
feeding  of  their  babies;  follow-up  work  in  the  homes  by  the  nurses,  especially  in 
the  case  of  sick  babies ;  and  cooperation  with  the  St.  Louis  Pure  Milk  Commission 
in  furnishing  safe  modified  milk  for  babies. 

On  June  1st  one  nurse  started  in  on  her  work,  the  number  being  rapidly  in- 
creased to  9.  Thirteen  stations  were  in  operation,  6  of  them  being  opened  for 
five  months, — from  May  1st  to  October  1st, — and  729  babies  being  enrolled. 
There  were  17  doctors,  9  nurses,  and  6  assistant  workers  engaged  in  the  work. 
Particular  stress  was  laid  upon  the  home  work,  and  during  the  latter  part  of  the 
season  a  considerable  number  of  the  mothers  were  taught  home  modification  of 
milk.  This  was  the  first  year  that  any  extensive  campaign  was  carried  out. 
Cooperation  between  various  organizations  was  extremely  good,  and  plans  are  in 
hand  for  a  more  extensive  campaign  in  1912. 

The  Health  Department  did  very  little  special  work  in  connection  with  the 
campaign.  Milk  inspection  in  St.  Louis  is  still  far  from  thorough,  owing  to  lack 
of  available  funds. 


CAMPAIGNS  IN  OTHER  CITIES 


99 


BOSTON 

The  following  table  gives  the  facts  in  regard  to  infant  mortality  in  Boston 
for  the  years  1906-1911: 

TABLE    71.— MORTALITY    UNDER    ONE    YEAR,    BOSTON 


1906 

1907 

1908 

1909 

1910 

Average 

Five 

Years 

1911 

187 
168 
186 
201 
197 
152 
240 
357 
271 
186 
165 
158 

177 
138 
96 
156 
185 
151 
172 
356 
282 
229 
147 
187 

197 
198 
208 
198 
182 
150 
305 
405 
300 
222 
186 
191 

175 
157 
192 
161 
146 
117 
188 
313 
240 
159 
124 
153 

163 
183 
189 
163 
140 
168 
225 
254 
270 
225 
148 
121 

179.8 
168.8 
174.2 
175.8 
170.0 
147.6 
226.0 
337.0 
272.6 
204.2 
154.0 
162.0 

163 

February 

175 

March 

196 

April        

191 

May 

180 

June 

129 

Tulv 

280 

August    

260 

September    

224 

October 

172 

November 

138 

December 

137 

Year   

2468 
21.62 

2276 
19.47 

2742 
23.28 

2125 
19.20 

2249 
19.45 

2372.0 

20.62 

2245 

Percentage  of  total  deaths 

19.08 

July,  August,  September 

868 
35.17 
30.62 

810 
35.58 

29.88 

1010 
36.83 
34.04 

741 
34.87 
29.25 

749 
33.30 
27.18 

835.6 

35.22 
30.27 

764 

Percentage  of  year' s  infant  mortality 

Percentage  of  all  deaths 

33.58 
25.10 

Births 

17,284 
142.8 

18,436 
123.4 

18,521 
*il48.0 

17,728 
119.8 

17,741 
126.7 

17,942 
132.2 

1258 

126.0 

It  will  be  noted  that,  excepting  1908,  a  very  high  year,  there  has  been  little 
striking  change  in  the  gross  figures.  In  percentages  of  total  mortality  1907,  1909, 
1910,  and  1911  remain  practically  the  same,  differing  only  in  a  small  fraction  of 
1  per  cent. 

In  the  totals  for  summer  mortality  the  last  three  years  have  been  very  nearly 
the  same,  being  slightly  higher  each  year.  The  infant  mortality  rate  shows  an 
increase  in  1910  and  1911  over  both  1907  and  1909.  The  rate  for  1911,  as  fur- 
nished by  the  Registrar  of  Vital  Statistics  for  Boston,  Dr.  Davis,  is  given  at  126, 
practically  the  same  as  in  1910. 

If  we  estimate  the  deaths  which  would  have  occurred  if  they  had  increased 
in  the  same  proportion  as  the  population,  1.96  [per  cent.,  yearly,  taking  1909,  the 
low  year  for  the  five-year  period,  as  a  basis,  and  then  compare  these  figures  with 
actual  deaths,  we  find  the  following: 

TABLE  72.— MORTALITY  UNDER  ONE  YEAR  WHICH  SHOULD  HAVE   OCCURRED 
ON   BASIS   OF    1909   FIGURES,   COMPARED   WITH   ACTUAL   MORTALITY, 

BOSTON 

1910  1911 

Estimated  mortality 2166  2208 

Actual  mortality 2249  2245 

Difference +83  +37 

Percentage  difference +3.8  +1»7 


100 


INFANT  MORTALITY  AND  MILK  STATIONS 


Estimating  for  the  three  summer  months,  taking  34.87  per  cent,  as  the  pro- 
portion of  deaths  occurring  during  these  months  in  1909,  we  have  the  figures 
shown  in  the  following  table: 

TABLE  73.— MORTALITY  UNDER  ONE  YEAR  IN  THREE  SUMMER  MONTHS  WHICH 

SHOULD  HAVE  OCCURRED  ON  BASIS  OF  1909  FIGURES,  COMPARED  WITH 

ACTUAL  MORTALITY,  BOSTON 

1910  1911 

Estimated  mortality 755  769 

Actual  mortality 749  764 

Difference 6  5 

Percentage  difference — 0.79  — 0.65 

Boston,  therefore,  shows  almost  no  improvement  in  infant  mortality  for  the 
year  compared  with  three  of  the  five  preceding  years.  The  summer  mortality 
has  not  been  reduced  in  the  last  three  years.  The  percentage  of  the  year's  in- 
fant deaths  occurring  during  the  three  summer  months  is  still  fairly  high,  as  is  the 
proportion  of  all  deaths  during  this  period. 

Taking  the  high  figure,  2742,  in  1908,  and  estimating  the  deaths  which  should 
have  occurred  on  the  basis  of  a  yearly  increase  of  1.96  per  cent.,  there  is  only  a 
decrease  of  22.7  per  cent.,  while  New  York  shows  for  the  year  1911  a  decrease  of 
20.4  per  cent,  from  the  lowest,  allowing  for  increase  in  population. 

Weather  Conditions 
The  weather  conditions  in  Boston  during  the  last  three  years  are  shown  in 
the  following  tables: 

TABLE  74.— NUMBER  OF  DAYS  ON  WHICH  MAXIMUM  AND    MEAN   TEMPERA- 
TURES REACHED  CERTAIN  FIGURES,  BOSTON* 


Maximxjm 

M 

EAN 

95°  or  + 

90°  or  + 

85°  or  + 

85°  or  + 

80°  or  + 

0 

4 

9 

0 

6 

1 

4 

8 

0 

4 

0 

3 

6 

0 

4 

0 

0 

0 

0 

0 

1 

11 

23 

0 

14 

0 

1 

6 

0 

2 

0 

6 

16 

0 

5 

0 

0 

4 

0 

0 

0 

0 

0 

0 

0 

0 

7 

26 

0 

7 

0 

0 

2 

0 

0 

8 

9 

14 

7 

10 

0 

3 

6 

0 

1 

0 

0 

1 

0 

0 

8 

12 

23 

7 

11 

1909 

June 

July 

August.  .  .  . 
September 

Total 
1910 

June 

July 

August.  .  . 
September 

Total 
1911 

June 

July 

August .  .  . 
September 

Total 


*  Monthly  Meteorological  Summary,  Local  Weather  Bureau,  Boston,  and  Monthly  Weather 
Review,  Washington,  D.  C. 


fiii 


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w 

H 

H 

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H 

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W 

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CAMPAIGNS  IN  OTHER  CITIES 


lOI 


TABLE   75.— MONTHLY   MEAN   TEMPERATURE,   RAINFALL,   AND   NUMBER   OF 

RAINY  DAYS,  BOSTON* 


Normal 

1909 

1910 

1911 

June 

Mean  temperature 

Rainfall 

Rainy  days 

July 

Mean  temperature 

Rainfall 

Rainy  days 

August 

Mean  temperature 
Rainfall 

66° 
3.08  in. 

72° 
3.18  in. 

70° 
3.84  in, 

63° 
3.33  in. 

69° 
4.45  in. 
8 

72° 
0.97  in. 

5  +  7 

69° 
3.55  in. 
8+3 

63° 
5.15  in. 
12  +  1 

65° 
4.89  in. 
12+2 

75° 
1.15  in. 
6  +  1 

69° 
0.98  in. 

7+2 

63° 
2.14  in. 
11  +  1 

66° 
3.67  in. 

8+7 

77° 
4.65  in. 
4+3 

69° 
4.18  In. 

Rainy  days 

September 

Mean  temperature 
Rainfall 

9+4 

63° 
2.95  in. 

Rainy  days 

10+1 

Totals 

Mean  temperature 
Rainfall 

68.7° 
13.33  in. 

68.2° 
14.12  in. 
32  +  11 

68.0° 

9.16  in. 
36+6 

68.7° 
15.45  in. 

Rainy  days 

31  +  15 

Note. — Two  figures  are  given  for  number  of  rainy  days — the  first,  in  front  of  the  plus  sign, 
is  the  number  of  days  precipitation  was  0.01  inch  or  more;  the  second,  after  the  plus  sign,  is  num- 
ber of  days  there  was  a  trace  of  precipitation,  but  less  than  G.Ol  inch. 


Except  for  the  month  of  July,  the  conditions  are  very  similar.  In  this 
month  the  temperature  reached  95°  or  over  on  eight  days  in  1911,  and  the  mean 
temperature  was  85°  or  over  on  seven  days.  The  high  figures  are  all  crowded  into 
the  first  two  weeks  of  July;  August  was  cool.  In  summing  up  the  monthly 
figures  compared  with  the  normal,  June  was  exactly  the  same.  July  was  5" 
over;  August  was  below;  September  was  the  same.  The  rainfall  the  first  three 
months  is  in  excess  of  the  normal;  September,  somewhat  below. 

Compared  with  1910,  June  was  1°  hotter;  July,  2°  hotter;  August  and  Sep- 
tember were  the  same.  In  1909  June  was  3°  hotter;  July,  5°  cooler;  August  and 
September,  the  same. 

The  rainfall  in  1911  was  less  in  June,  much  more  in  July  and  August,  and 
less  than  1909  in  September,  but  more  than  in  1910.  It  was  less  evenly  distri- 
buted throughout  the  summer  than  either  year. 

The  Campaign 

In  Boston  practically  the  only  organization  doing  purely  baby  work,  and 

laying  particular  stress  on  prevention,  is  the  Boston  Milk  and  Baby  Hygiene 

Association.     In   1905   a  group  of  public-spirited  citizens  organized  a   "poor 

people's"  modified  milk  service.     They  distributed  milk  already  modified  to 

*  Monthly  Meteorological  Summary,  Local  Weather  Bureau,  Boston,  and  Monthly  Weather 
Review,  Washington,  D.  C. 


102  INFANT  MORTALITY  AND  MILK  STATIONS 

various  settlements,  day  nurseries,  etc.  In  1907  a  committee  on  modified  milk 
stations  was  organized  to  take  charge  of  the  work.  After  a  year  this  committee 
came  to  the  conclusion  that  its  poHcy  was  unintentionally  encouraging  weaning, 
and  a  new  method  was  adopted.  In  1909  they  opened  10  milk  stations,  under 
the  control  of  the  Committee  on  Milk  and  Baby  Hygiene.  A  director  was 
appointed,  and  consultations  were  inaugurated,  under  volunteer  physicians, 
a  medical  director,  and  trained  nurses. 

In  1910  the  association  was  incorporated,  and  has  been  carrying  on  the  work 
since.  Twenty  volunteer  physicians  have  charge  of  the  10  stations;  consulta-  j 
tions  are  held  from  once  to  three  times  a  week ;  modified  milk  is  dispensed ;  earnest  1 
efforts  are  made  to  encourage  breast-feeding ;  mothers  receive  home  instruction ; 
all  sick  babies  are  referred  to  physicians  or  dispensaries ;  sick  babies  are  referred 
also  to  the  Instructive  Visiting  Nurses'  Association,  whose  nurses  care  for  the 
babies  while  sick. 

In  1911,  9  stations  were  maintained;  10  nurses  were  in  the  field;  13  volunteer 
physicians  had  charge  of  consultations.  Home  modification  was  taught  "where 
possible." 

In  1909  and  1910  the  Women's  Municipal  League  carried  on  a  demonstration 
of  prenatal  and  postnatal  instruction  to  mothers.  They  have  since  discontinued 
their  postnatal  work,  which  was  planned  as  a  demonstration. 

The  work  in  Boston  in  1911  showed  no  increase  except  in  efficiency,  perhaps, 
over  that  done  in  the  three  previous  years.  The  work  of  the  Milk  and  Baby 
Hygiene  Association  has  been  excellent,  but  it  cannot  reach  more  than  a  small 
proportion  of  those  who  need  its  aid. 

The  Health  Department  had  two  nurses  in  the  field  doing  prophylactic 
work,  including  prenatal  instruction. 


CAMPAIGNS  IN  OTHER  CITIES 


103 


CLEVELAND 

In  considering  the  mortality  returns  for  Cleveland,  it  must  be  remembered 
that,  with  the  exception  of  Detroit  and  the  three  boroughs  of  Bronx,  Queens,  and 
Richmond  in  New  York,  the  percentage  increase  in  population  during  the  past 
decade  has  been  greater  than  in  any  of  the  other  cities  considered.  The  following 
table  shows  the  details  of  the  infant  mortality  for  the  years  1906  to  1911  inclusive: 


TABLE  76.— MORTALITY  UNDER  ONE  YEAR,  CLEVELAND 


1906 


1907 


1908 


1909 


1910 


Aver- 
age 
1906-10 


1911 


January 

February 

March 

April 

May 

June 

July 

August 

September 

October 

November 

December 

Year 

Percentage  of  all  deaths 

July,  August,  and  September 

Percentage  of  year's  infant  mortality 
Percentage  of  all  deaths 

Births 

Infant  mortality  rate 


108 
145 
180 
194 
123 
215 
272 
176 
145 
122 
121 
124 


166 

162 
170 
150 
137 
124 
164 
304 
188 
175 
113 
135 


153 
144 
171 
135 
119 
104 
240 
209 
142 
142 
128 
114 


133 
148 
170 
142 
117 
99 
204 
213 
137 
126 
108 
114 


134 
141 
194 
132 
147 
157 
322 
278 
174 
128 
127 
123 


139 
148 
177 
150 
128 
140 
140 
136 
157 
138 
119 
123 


163 
147 
147 
148 
140 
137 
225 
199 
145 
124 
92 
121 


1925 
26.1 


1988 
25.9 


1801 
25.7 


1711 
24.5 


2057 
25.6 


1896 

25.5 


1788 
23.4 


593 
30.8 
30.2 


656 
33.0 
30.1 


591 
32.8 
33.2 


554 
32.4 
30.3 


774 
37.6 
35.3 


634 

33.4 
32.7 


569 
32.0 
38.5 


11,201 
171.9 


10,700 
185.8 


12,010 
150.0 


13,100 
130.6 


13,456 
152.9 


12,093 
156.8 


12,589 
142.0 


During  the  years  1906-09  inclusive  there  was  a  steady  diminution  in  the 
total  number  of  deaths  under  one  year  and  in  the  proportion  of  all  deaths.  The 
year  1910  showed  a  sharp  rise  both  in  the  year's  total  and  during  the  summer 
months,  the  proportion  of  the  mortality  occurring  during  the  summer  months 
being  the  highest  in  any  of  the  years  considered. 

On  the  other  hand,  1911  had  a  lower  total  mortality  than  any  year  except 
1909,  The  same  is  true  of  the  summer  mortality,  and  the  percentage  of  all  deaths 
both  for  the  year  and  for  the  summer  months ;  the  proportion  of  the  year's  deaths 
occurring  during  the  three  summer  months  is  also  lower  than  any  year  except  1906. 
The  greatest  reduction,  therefore,  occurred  during  the  summer  months,  but  there 
is  a  marked  fall  for  the  entire  year. 

In  the  following  table  is  shown  the  compari'^on  of  19irs  figures  with  those  of 
other  years: 


104 


INFANT  MORTALITY  AND  MILK  STATIONS 


TABLE   77— DIFFERENCE   BETWEEN  MORTALITY  UNDER  ONE  YEAR  IN   1911  | 
AND  OTHER  YEARS,  CLEVELAND 


Year 

Percentage  all  deaths 

July,  August,  and  September .  . 

Percentage  of  year's  infant  mortality 
Percentage  all  deaths   


1906 

1907 

1908 

1909 

—137 

—210 

—13 

+77 

—3.7 

—3.5 

—3.3 

—2.1 

—24 

—87 

—22 

+  15 

+  1.2 

—1.0 

—0.8 

—0.4 

—1.7 

—1.6 

—4.7 

—1.8 

1910 


If,  now,  we  compare  the  results  in  1911  with  those  in  1909,  allowing  for  the  ' 
increase  in  population,  we  find  results  shown  in  the  following  table: 

TABLE  78.— MORTALITY  UNDER  ONE  YEAR  WHICH  SHOULD  HAVE  OCCURRED, 
BASED  ON  1909  FIGURES,  COMPARED  WITH  ACTUAL  MORTALITY,  CLEVE- 
LAND 


Estimated  mortality 
Actual  mortality.  .  . 
Difference,  actual .  .  - 
Per  cent,  difference . 


Yearly  rate  of  increase  in  population,  4.69  per  cent. 

The  year  1910  showed  266,  or  14.8  per  cent.,  above  1909's  figures,  allowing 
for  the  increase  in  population;  whereas  1911  was  83,  or  4.4  per  cent.,  less. 

There  was,  therefore,  a  distinct  improvement  in  the  infant  mortality  condi- 
tions in  Cleveland,  although  if  the  registration  of  births  is  anywhere  near  com- 
plete, the  death-rate  is  still  very  high,  and  there  is  not  the  same  degree  of  im- 
provement noted  as  in  a  number  of  other  cities. 


Weather  Conditions 

The  weather  conditions  in  Cleveland  are  shown  in  Tables  79  and  80. 

In  1909  in  no  month  was  the  temperature  above  the  normal.  On  only  one 
day  did  it  reach  90°,  and  the  mean  daily  temperature  reached  80°  only  on  one 
day.  In  1910  the  temperature  for  the  month  was  1°  higher  than  the  normal  in 
September.  The  mean  for  the  four  months  was  0.5°  below  the  normal;  and  again 
there  was  only  one  day  when  90°  or  over  was  recorded.  The  mean  was  80°  or  + 
on  four  days. 

In  1911  all  four  months  were  above  the  normal,  and  the  mean  for  four  months 
was  1.3°  above.  Individual  days  of  high  temperature  also  were  more  numerous; 
95°  or  over  was  reached  once,  90°  or  over  seven  times.  Twice  the  mean  daily 
temperature  was  85°  or  over  and  9  times  80°  or  over.  The  high  temperatures 
were  scattered  through  the  summer,  except  in  July,  when  on  four  consecutive 
days  90°  or  over  was  reached  (July  2d  to  5th).     The  rest  of  July  was  cool. 


CAMPAIGNS  IN  OTHER  CITIES 


105 


TABLE   79.— NUMBER  OF   DAYS   ON  WHICH  THE   MAXIMUM  AND  MEAN  TEM- 
PERATURE REACHED  CERTAIN  FIGURES,  CLEVELAND* 


1909 

June 

July 

August.  .  . 
September 

Total 
1910 

June 

July 

August.  .  . 
September 

Total 
1911 

June 

July 

August .  .  . 
September 

Total 


95°  or  + 


Maxiitum 


90°  or  + 


85°  or  + 


20 


11 

0 

0 

0 

7 

0 

8 

0 

1 

0 

16 

0 

6 

0 

7 

2 

6 

0 

1 

0 

Mean 


85°  or  +  80°  or  + 


TABLE   80.— MONTHLY   MEAN   TEMPERATURE,    RAINFALL,   AND   NUMBER   OF 

RAINY  DAYS,  CLEVELAND* 


Normal 

1909 

1910 

1911 

June 

Mean  temperature 
Rainfall 

67° 
3.51  in. 

73° 
3.56  in. 

70° 

3.87  in. 

64.1° 
3.33  in. 

67° 
3.72  in. 
13 

70° 

3.12  in. 
9+5 

70° 

2.31  in, 
10+3 

62° 
3.40  in. 
10+3 

64° 
2.01  in. 
9+3 

72° 

0.94  in. 
9+3 

70° 

1.08  in. 
6+0 

65° 

4.09  in. 
11+2 

69° 

2.88  in. 

Rainy  days 

July 

Mean  temperature 

Rainfall 

Rainy  days 

August 

Mean  temperature 
Rainfall 

10+5 

73° 
1.71  in. 

7+5 

71° 
5.18  in. 

Rainy  days 

September 

Mean  temperature 

Rainfall 

Rainy  days 

11+5 

65° 

4.67  in. 
11+3 

Totals 

Mean  temperature 
Rainfall 

68.3° 
13.30  in. 

67.2° 
12.55  in. 
42  +  11 

67.7° 
8.12  in. 

35+8 

69.5° 
14.44  in. 

Rainy  days 

39  +  18 

Note. — Two  figures  are  given  for  number  of  rainy  days — the  first,  in  front  of  the  plus  sign,  is 
the  number  of  days  precipitation  was  0.01  inch  or  ^more;  the  second,  after  the  plus  sign,  is  the 
number  of  days  there  was  a  trace  of  precipitation,  but  less  than  0.01  inch. 

*  Monthly  Meteorological  Summary,  Local  Weather  Bureau,  Cleveland,  and  Monthly 
Weather  Review,  Washington,  D.  C. 


io6  INFANT  MORTALITY  AND  MILK  STATIONS 

The  weather  conditions  were  less  favorable  for  a  low  infant  mortality  in  1911 
than  in  1909  or  1910,  except  in  regard  to  rainfall,  the  most  marked  advantage  in 
this  respect  in  1911  being  in  August. 

The  Campaign 

In  1899  a  Milk  Fund  Association  was  formed,  which  distributed  clean  milk 
in  bulk  to  any  one  who  desired  to  buy  it.  In  1906  the  Infants'  Clinic  was 
established  by  the  Milk  Fund  Association  and  the  Visiting  Nurse  Association,  to 
provide,  during  the  summer,  medical  counsel,  nursing  care,  and  instruction  in  the 
homes  pnd  clean  milk  for  sick  babies  in  its  neighborhood.  The  clinic  was  so  ! 
successful  that  it  became  evident  that  a  permanent  organization  was  needed. 
The  value  of  the  home  nursing  was  demonstrated  beyond  question. 

In  December,  1906,  the  Babies'  Dispensary  and  Hospital  of  Cleveland  was 
incorporated.  A  medical  director  was  appointed,  and  Dr.  Gerstenberger  has 
continued  from  its  founding  to  devote  his  time  and  thought  to  the  undertaking. 
It  is  largely  due  to  him  and  his  clear  conception  of  the  problem  that  the  work  has 
succeeded  as  it  has.  In  May,  1907,  the  dispensary  and  the  milk  laboratory  were 
opened.  Three  visiting  nurses  were  provided,  and  two  dispensary  physicians 
appointed.     Milk  was  modified  at  the  central  plant  and  distributed  by  hand. 

In  1908  an  out-physician  was  added  to  the  staff  to  visit  cases  too  sick  to 
come  to  the  dispensary.  Four  nurses  were  employed,  who  made  8503  visits. 
Milk  was  still  delivered  to  tlie  homes  with  a  wagon.  Considerable  modification 
of  milk  was  done  at  the  home  by  mothers;  those  incapable  of  doing  so  received 
already  modified  milk. 

Particular  stress  was  laid  on  the  educational  side  and  to  the  encouragement 
of  maternal  nursing. 

In  1909  four  branch  dispensaries  were  formed.  Great  cooperation  existed 
between  the  Milk  Fund  Association,  the  Visiting  Nurses'  Association,  the  Health 
Department,  and  various  settlement  houses.  An  outdoor  ward  was  established 
where  sick  babies  were  treated — at  first  from  8  A.  M.  to  6  p.  m.,  and  later  day  and 
night.  The  Milk  Fund  Association  became  amalgamated  with  the  dispensary, 
thus  putting  the  work  on  a  more  rational  basis. 

In  1910  there  were  6  branch  dispensaries.  A  vigorous  campaign  of  education 
for  reduction  of  infant  mortality  was  carried  out,  and  was  participated  in  by  a 
large  number  of  civic  and  philanthropic  organizations. 

In  1911  the  New  Central  Dispensary  was  built  and  in  operation.  The  City 
Council  appropriated  $10,000  for  the  reduction  of  infant  mortaUty,  and  5  new 
stations  were  opened,  making  a  total  of  11  with  60  distributing  stations.  Two 
were  managed  by  the  Health  Department,  but,  owing  to  the  wonderful  coopera- 
tion which  existed,  the  Babies'  Dispensary  and  the  Health  Department  worked 
together.  In  October,  5  of  the  branch  dispensaries  were  taken  over  by  the  city. 
A  Bureau  of  Child  Hygiene  was  formed,  and  in  September  Dr.  Gerstenberger 
became  its  head.  Cleveland  is  a  fortunate  city  in  the  complete,  broad  coopera- 
tion that  has  marked  its  infant  mortality  work,  especially  in  recent  years. 


CAMPAIGNS  IN  OTHER  CITIES 


107 


BALTIMORE 

In  the  following  tables  is  set  forth  the  infant  mortality  by  months  and  groups 
of^months,  with  the  percentage  of  all  deaths  occurring  under  one  year  of  age  for 
the  years  1907  to  1911: 


TABLE  81— MORTALITY  UNDER  ONE  YEAR,  BALTIMORE 


January 

February 

March 

April 

May 

June 

July 

August 

September 

October 

November 

December 

Year 

Percentage  all  deaths 

July,  August,  September 

Percentage  of  year's  infant  mortality 
Percentage  all  deaths 


1907 


167 
153 
182 
134 
139 
140 
397 
370 
239 
215 
145 
162 


2443 
31.84 


1908 


180 
160 
166 
157 
157 
201 
399 
233 
184 
138 
123 
117 


2215 
31.36 


1909 


155 
139 
161 
162 
173 
168 
317 
264 
215 
172 
157 
144 


2227 
31.43 


176 
170 
148 
132 
114 
183 
306 
266 
180 
190 
138 
145 


2148 
19.97 


1911 


143 
138 
165 
141 
152 
125 
280 
254 
182 
132 
109 
137 


1958 
18.83 


1006 
41.10 
34.01 


816 
36.84 
31.14 


796 
35.74 
39.35 


752 
35.01 
38.05 


716 
36.57 
38.33 


From  this  table  it  will  be  seen  that  the  gross  figures  for  the  years  have  had  a 
steady  tendency  to  diminish,  and  that  this  tendency  has  been  increasingly  marked 
in  1910  and  1911.  The  relation  of  the  deaths  under  one  year  to  total  deaths  re- 
mained practically  constant  during  the  first  three  years  shown  in  the  table,  but 
has  steadily  fallen  in  1910  and  1911. 

Comparing  the  summer  mortality,  there  is  the  same  steady  decrease  in  the 
gross  figures.  The  decrease,  however,  has  been  slow.  The  proportion  of  the 
year's  deaths  under  one  occurring  during  the  three  summer  months  in  1911  was 
higher  than  in  either  1909  or  1910.  There  is  also  a  slight  increase  in  the  propor- 
tion of  all  deaths  during  the  three  summer  months  which  are  under  one  year  of 
age.  In  other  words,  there  was  a  greater  proportionate  decrease  during  the  rest 
of  the  year  than  during  the  summer  months. 

The  population  of  Baltimore  increased  9.7  per  cent,  in  the  decade  1900-10,  or 
0.97  per  cent,  yearly.  If  we  estimate  the  deaths  which  would  have  occurred  had 
the  total  increased  0.97  per  cent,  yearly  from  1908,  which  was  the  low  figure  up 
to  1910,  and  then  note  the  difference  between  this  estimate  and  the  deaths  that 
did  occur,  we  shall  have  the  results  shown  in  the  following  table : 


io8  INFANT  MORTALITY  AND  MILK  STATIONS 

TABLE  82.— MORTALITY  UNDER  ONE  YEAR  WHICH  SHOULD  HAVE  OCCURRED, 
BASED  ON  1908  FIGURES,  COMPARED  WITH  ACTUAL  MORTALITY,  BAL-  ^ 

TIMORE 


1909 

1910 

1911 

2236 
2227 

—9 

—0.4 

2257 

2148 

—109 

—4.8 

2279 

1958 

—321 

—14.0 

Yearly  average  increase  in  population,  0.97  per  cent. 

The  results,  as  shown  by  the  yearly  figures,  are  therefore  good.  The  re- 
duction in  the  summer  mortality,  however,  is  slight,  and  there  is  still  a  very  high 
proportion  of  the  year's  infant  deaths  occurring  during  the  summer  months. 

Birth  statistics  for  Baltimore  are  of  no  value. 


Weather  Conditions 
The  following  tables  show  weather  conditions  in  Baltimore: 

TABLE  83.— NUMBER  OF  DAYS  ON  WHICH  MAXIMUM  AND  MEAN  TEMPERA- 
TURES REACHED  CERTAIN  FIGURES,  BALTIMORE* 


Maximum  Temperature 

Mean  Temperature 

95°  or  + 

90°  or  + 

85°  or  + 

85°  or  + 

80°  or  + 

1909 

June 

0 
0 
1 
0 

1 

0 

1 
0 

1 

2 

1 

7 
2 
0 

10 

9 

7 
6 
0 

22 

4 

15 

1 

2 

22 

7 

11 
6 
0 

24 

13 

16 

13 

0 

42 

10 

23 

9 

5 

47 

10 

20 

14 

6 

50 

1 
1 
1 
0 

3 

1 
2 
0 
1 

4 

1 
7 
2 
0 

10 

9 

July 

9 

August 

6 

September 

Total 

0 
24 

1910 

June 

6 

July 

16 

August 

3 

September 

3 

Total 

28 

1911 

June 

4 

July 

August 

14 
9 

September 

Total 

1 

28 

*  Monthly   Meteorological  Summary,   Local  Weather   Bureau,   Baltimore,   and   Monthly 
Weather  Review,  Washington. 


CAMPAIGNS  IN  OTHER  CITIES 


109 


TABLE   84— MONTHLY   MEAN   TEMPERATURE,    RAINFALL,    AND    NUMBER   OF 

RAINY  DAYS,  BALTIMORE* 


June 
Mean  temperature 

Rainfall 

Rainy  days 

July 
Mean  temperature 

Rainfall 

Rainy  days 

August 

Mean  temperature 

Rainfall 

Rainy  days 

September 

Mean  temperature 

Rainfall 

Rainy  days 

Totals 

Mean  temperature 

Rainfall 

Rainy  days 


Normal 


73° 
3.84  in. 


77.3° 

4.82  in. 


74.7° 
4.31  in. 


68.6° 
3.85  in. 


73.4° 
16.73  in. 


74.1° 
4.38  in. 
13+8 

76° 
1.31  in. 

5  +  7 

74.4° 
0.86  in. 

5+3 

67.6° 
3.97  in. 

5  +  5 

73.02° 
10.52  in. 

28+23 


70.4° 
5.3  in. 
14+1 

78.8° 
0.95  in. 

7+2 

74.3° 

1.37  in. 
11+3 

71.6° 
2.13  in. 

4  +  7 

73.7° 
9.75  in. 
36  +  13 


73.4° 

5.52  in. 
16 

79.2° 

3.53  in. 
6+4 

76.2° 
12.28  in. 
15+4 

70.4° 
1.6  in. 

7  +  1 

74.8° 
22.93  in. 
44+9 


Note. — Two  figures  are  given  for  number  of  rainy  days — the  first,  in  front  of  the  plus  sign,  is 
the  number  of  days  precipitation  was  0.01  inch  or  more;  the  second,  after  the  plus  sign,  is  the 
number  of  days  there  was  a  trace  of  precipitation,  but  less  than  0.01  inch. 

For  maximum  temperatures  below  95°  and  mean  temperatures  below  85° 
there  is  a  very  close  resemblance  between  the  three  years.  But  temperatures  of 
95°  or  over  were  recorded  10  times  in  1911,  as  against  twice  in  1910  and  once  in 
1909.  Mean  temperatures  of  85°  or  over  were  also  recorded  10  times  in  1911  as 
against  4  times  in  1910  and  3  times  in  1909. 

The  monthly  mean  temperatures  in  1911  were  well  above  the  normal  in  each 
month,  while  in  1909  only  June,  and  in  1910  only  July  and  September,  exceeded 
the  normal.  The  year  1911  had  a  higher  monthly  mean  than  1909  in  each  month 
except  June,  and  higher  than  1910  in  each  month  except  September. 

Rainfall,  on  the  other  hand,  was  much  greater  in  1911  than  in  either  1909 
or  1910,  except  in  September,  and  exceeded  the  normal  in  the  months  of  June 
and  August.  August  had  the  remarkable  rainfall  of  12.28  inches,  which  is  2.79 
inches  greater  than  any  recorded  in  August  since  the  establishment  of  the  Weather 
Bureau. 

The  Campaign 

The  chief  agencies  engaged  in  work  for  the  reduction  of  infant  mortality  in 
Baltimore  are  the  Babies'  Milk  Fund  Association  and,  to  a  much  less  extent,  the 
Mothers'  Relief  Society.  The  latter  society  was  founded  in  the  early  nineties,  its 
purpose  being  the  assistance  of  the  mothers  during  and  after  confinement. 

The  Babies'  Milk  Fund  was  started  in  1904,  when  the  Thomas  Wilson  Sani- 
tarium established  four  milk  stations  in  distant  parts  of  the  city.     The  work  was 


*  Monthly  Meteorological    Summary,   Local  Weather   Bureau,   Baltimore,   and   Monthly 
Weather  Review,  Washington,  D.  C. 


no  INFANT  MORTALITY  AND  MILK  STATIONS 

shown  to  be  of  such  value  that,  after  a  few  years,  the  Babies'  Milk  Fund  Associa- 
tion was  incorporated.  Funds  were  raised  by  popular  subscription,  the  Thomas 
Wilson  Sanitarium  being  the  largest  contributor. 

Babies  were  referred  to  the  stations  from  hospitals,  dispensaries,  and  private 
physicians.  Milk  modified  to  set  formulae  was  dispensed,  and  special  formulae 
could  be  secured.  Milk  was  dispensed  by  trained  nurses,  who  gave  the  greater 
part  of  the  day  to  visiting  at  the  homes,  instructing  and  demonstrating. 

In  1910  the  two  above-mentioned  organizations  united  to  form  the  Maryland 
Association  for  the  Study  and  Prevention  of  Infant  Mortality.  It  was  managed 
by  a  committee  composed  of  representatives  of  both  organizations.  After  one 
year  the  Mothers'  Relief  Society  withdrew. 

In  1911  the  work  done  increased  considerably  in  efficiency  and  also  in  extent. 
Nine  stations  are  now  maintained,  open  all  the  year  round.  They  are  in  charge 
of  a  trained  nurse.  Babies  are  referred  by  physicians  and  organizations,  and 
there  is  little  or  no  house-to-house  canvassing.  Milk  already  modified  is  supplied 
from  six  of  the  stations.  From  the  other  three  home  modification  is  practised 
and  taught,  tuberculin-tested  milk  being  delivered  directly  to  the  mothers'  homes, 
and  the  modification  taught  by  the  nurse.  At  the  first  two  visits  she  modifies  for 
the  mother,  and  at  the  last  visit  watches  the  mother  do  it.  This  latter  work — 
home  modification — was  started  in  1911. 

A  weekly  clinic  is  held  at  each  station,  when  babies  are  weighed  and  mothers 
instructed.  Great  emphasis  is  laid  on  breast-feeding.  Instruction  is  individual, 
not  in  classes.  Attendance  is  not  compulsory;  milk  is  delivered  whether  they 
attend  or  not.  During  the  year  Dr.  Henrietta  Thomas  has  been  conducting 
follow-up  work  for  cases  discharged  from  the  Johns  Hopkins  Maternity  ser- 
vices. She  has  had  500  babies  under  her  care.  They  are  also  visited  by  the 
association  nurses  from  time  to  time.     Milk  is  not  dispensed  to  these  babies. 

The  work  of  the  association  is  being  widened  in  its  scope  by  the  establish- 
ment of  welfare  clinics  at  six  of  the  stations,  and  by  prenatal  work  among  ex- 
pectant mothers  referred  by  three  hospitals  in  Baltimore. 

The  number  of  babies  supplied  with  milk  by  the  stations  has  been  as  follows: 

TABLE  85.— NUMBER  OF  BABIES  FED  AT  MILK  STATIONS  IN  BALTIMORE  AND 

MORTALITY  AMONG  SAME 

Deaths  Rate 

February,  1908,  to  February,  1909 1073  103  96.0  per  1000 

1909,  to   "     1910 1217  105  86.3  "   " 

1910,  to   "    1911 1356  188  138.7  "   " 

1911,  to   "    1912 1194  50  41.9  "   " 

Of  these  1194  babies  in  1911-12,  927  were  supplied  with  modified  milk;  267 
with  whole  milk  modified  at  home. 

The  Department  of  Health  has  done  little  active  special  work,  owing  to  lack 
of  funds.  During  the  last  two  years  considerable  interest  in  the  problem  has 
been  aroused  by  the  annual  meeting  of  the  American  Association  for  the  Study 
and  Prevention  of  Infant  Mortality  in  1910,  and  by  general  exhibits  on  Baby 
Hygiene,  etc. 


CAMPAIGNS  IN  OTHER  CITIES 


III 


PITTSBURGH 
The  following  table  shows  the  infant  mortality  statistics  for  the  years  1907-1 1 
n  Pittsburgh: 

TABLE  86— MORTALITY  UNDER  ONE  YEAR,  PITTSBURGH 

1911 


fanuary 

February 

March 

'^pril 

May 

June 

[uly 

August 

September 

October 

November 

December 

Year 

Percentage  all  deaths 

July,  August,  September 

Percentage  years  infant  mortality 
Percentage  all  deaths 


1907 

1908 

1909 

1910 

129 

223 

177 

162 

146 

259 

157 

176 

137 

183 

120 

185 

139 

172 

131 

169 

148 

142 

140 

148 

148 

160 

153 

166 

244 

251 

273 

338 

189 

214 

184 

231 

127 

176 

164 

178 

126 

144 

143 

191 

112 

143 

134 

157 

159 

127 

147 

150 

1804 

2194 

1923 

2251 

24.45 

24.29 

23.04 

23.43 

560 

641 

621 

747 

31.04 

29.20 

32.29 

33.18 

29.83 

31.08 

31.19 

33.33 

171 
134 
151 
142 
131 
116 
250 
197 
144 
132 
118 
124 


1810 
22.33 


591 
32.65 
27.75 


It  will  be  seen  that  in  1911  the  year's  total  is  the  lowest  since  1907,  which 
year  was  6  below  19irs  figures.  The  percentage  of  the  total  deaths  occurring 
under  one  year  of  age  is  lower  than  in  any  year,  including  1907. 

During  the  summer  months  the  deaths  were  591,  the  lowest  total  of  the  five 
years  except  1907.  The  percentage  of  the  year's  mortality  which  occurred 
during  these  three  months  was  lower  than  in  1910,  but  higher  than  in  1907,  1908, 
or  1909. 

If,  now,  taking  as  a  basis  the  figures  of  1907,  the  lowest  year  up  to  1911,  we 
estimate  the  deaths  as  increasing  at  the  same  rate  as  the  population,  and  compare 
the  actual  deaths  with  these  figures,  we  find  the  results  shown  in  the  following 
table : 

TABLE  87.— MORTALITY  UNDER  ONE  YEAR  WHICH  SHOULD  HAVE  OCCURRED, 
BASED  ON  1907  FIGURES,  COMPARED  WITH  THE  ACTUAL  MORTALITY, 

PITTSBURGH 


1908 

1909 

1910 

1911 

Estimated  mortality 

1836 

2194 

+358 

+19.5 

1869 
1923 

+54 
+2.8 

1902 

2251 

+349 

+18.3 

1935 

Actual  mortality 

1810 

Actual  difference 

—125 

Per  cent,  difference 

—6.4 

Average  yearly  increase  in  population,  1.82  per  cent. 


112  INFANT  MORTALITY  AND  MILK  STATIONS 

These  figures  show  that  in  each  of  the  years  1908,  1909,  and  1910  more  deaths 
occurred  than  the  estimate,  while  1911  alone  shows  a  decrease  of  6.4  per  cent, 
from  the  estimate. 

There  has,  therefore,  been  a  very  decided  improvement  this  year  over  pre- 
vious years.  The  proportion  of  infant  deaths  occurring  during  the  three  summer 
months  has  not,  however,  fallen  as  much  as  in  other  places. 


Weather  Conditions 
Weather  conditions  are  shown  in  Tables  88  and  89. 

TABLE  88.-  NUMBER  OF  DAYS  ON  WHICH  MAXIMUM  AND  MEAN  TEMPERA- 
TURES REACHED  CERTAIN  FIGURES,  PITTSBURGH* 


1909 

June 

July 

August.  .  . 
September 

1910 

June 

July 

August .  .  . 
September 

1911 

June 

July 

August .  .  . 
September 


Maximum  Temperature 


95°  or  +  90°  or  + 


2 
1 
1 
0 

4 

4 
8 
6 
0 

18 


85°  or  + 


24 

10 

13 

10 

1 

34 

5 

17 
18 

3 

43 


Mean  Temperature 


85°  or  +  80°  or  + 


0 
3 
0 
0 

3 

2 
9 
7 
0 

18 


Extremely  high  temperatures  were  reached  more  often  in  1911  than  in  either 
1910  or  1909,  especially  as  compared  with  the  latter  year.  In  neither  1909  nor 
1910  was  95°  recorded.  The  same  general  relation  is  true  for  the  daily  means. 
The  hot  weather  was  especially  severe  in  July  and  August,  1911  (during  forty- 
eight  days  beginning  July  1st  the  thermometer  reached  85°  or  over  on  thirty-two 
days).  In  neither  1909  nor  1910  did  the  mean  reach  85°,  against  six  and  four  days 
in  July  and  August,  1911. 

The  monthly  mean  temperatures  are  very  much  the  same  in  1910  and  1911, 
differing  only  in  August,  when  in  1911  it  was  1°  hotter,  and  June,  when  it  was  4" 
hotter.  All  four  months  of  1911  are  above  the  normal  averages.  June,  1909  and 
1911,  were  the  same,  but  all  other  months  were  much  below  in  1909. 

*  Monthly  Meteorological  Summary,  Local  Weather  Bureau,  Pittsburgh,    and  Monthly 
Weather  Review,  Washington,  D.  C. 


The  Station  Nurse  Insists  Upon  Maternal  Nursing  Wherever  Possible 


CAMPAIGNS  IN  OTHER  CITIES 


113 


TABLE   89.— MONTHLY   MEAN   TEMPERATURE,   RAINFALL,   AND   NUMBER   OF 

RAINY  DAYS,  PITTSBURGH* 


Normal 

1909 

1910 

1911 

June 

Mean 

Rainfall 

Rainy  days 

Mean 

Rainfall 

Rainy  days 

August 

Mean 

70.7° 
3.71  in. 

74.8° 
4.39  in. 

73.8° 
3.07  in. 

66.7° 
2.48  in. 

71° 
4.92  in. 
16 

71° 
1.22  in. 
9+6 

72° 
3.33  in. 
9+5 

65° 
0.76  in. 
8 

67° 

1.94  in. 
13+3 

75° 
1.26  in. 
9+4 

73° 
2.47  in. 
8  +  1 

68° 
5.5  in. 
10+4 

71° 
2.63  in. 
9+6 

75° 
2.17  in. 

7+6 

74° 

Rainfall 

Rainy  days 

September 

Mean 

6.3  in. 
13+4 

68° 

Rainfall 

Rainy  days 

6.36  in. 
13+4 

Totals 

Mean 

71.2° 
13.65  In. 

69.7° 
10.23  in. 
42  +  11 

70.7° 
11.17  in. 
40  +  12 

72° 

Rainfall 

Rainy  days 

17.46  in. 
42+20 

Note. — Two  figures  are  given  for  number  of  rainy  days — the  first,  in  front  of  the  plus  sign,  is 
the  number  of  days  precipitation  was  0.01  inch  or  more;  the  second,  after  the  plus  sign,  is  num- 
ber of  days  there  was  a  trace  of  precipitation,  but  less  than  0.01  inch. 

The  rainfall  in  August  and  September,  1911,  was  above  the  normal,  and  also 
above  either  1909  or  1910,  especially  in  August.  June  and  July  were  below  the 
normal,  but  in  excess  of  1910  in  June  and  in  excess  of  both  years  in  July. 

It  has  been  impossible  to  obtain  information  first  hand  in  regard  to  the  work 
being  done  in  Pittsburgh. 

*  Monthly  Meteorological  Summary,  Local  Weather  Bureau,  Pittsburgh,  and  Monthly 
Weather  Review,  Washington,  D.  C. 


114 


INFANT  MORTALITY  AND  MILK  STATIONS 


DETROIT 

In  studying  the  mortality  figures  for  Detroit  it  must  be  remembered  that  the 
population  has  increased  63  per  cent,  in  ten  years.  The  following  tables  give 
the  statistics  of  infant  mortality  for  the  years  1906  to  1911: 


TABLE  90.— MORTALITY  UNDER  ONE  YEAR,  DETROIT 

1906 

1907 

1908 

1909 

1910 

Average 
1906-10 

1911 

97 
113 
137 
147 
145 
134 
221 
172 
154 
136 
116 
107 

124 
107 
153 
114 
119 
103 
186 
198 
166 
133 
100 
95 

126 
141 
165 
180 
119 
117 
206 
207 
162 
131 
91 
89 

130 
126 
149 
150 
140 
114 
211 
220 
171 
149 
114 
127 

148 
132 
200 
196 
141 
198 
275 
251 
182 
125 
118 
129 

135 
134 
161 
157 
133 
133 
330 
309 
167 
135 
108 
109 

160 

154 

March         

138 

April              

104 

May                

150 

133 

Tulv 

244 

August    

215 

September 

179 

October 

130 

November 

121 

December 

134 

Year 

1679 
38.0 

1598 
36.4 

1734 
39.5 

1801 
38.5 

2095 
38.1 

1781 

28.1 

1862 

Percentage  of  all  deaths 

36.1 

July,  August,  and  September 

Percentage  year's  infant  mortality 

547 
33.6 
33.3 

550 
34.4 
35.8 

575 
33.6 
38.5 

602 
33.4 
36.0 

708 
33.8 
35.3 

596 

33.5 
35.7 

638 
34.3 
34.0 

Births 

7752 
216.5 

8341 
191.5 

9572 
181.1 

9617 

187.2 

11,509 
182.0 

9358 
190.3 

13,373 

Infant  mortality  rate 

139.2 

TABLE  91.— DIFFERENCE   BETWEEN   MORTALITY   UNDER  ONE  YEAR   IN   1911 
AND  PREVIOUS  YEARS,  DETROIT 


1906 

1907 

1908 

1909 

1910 

Year 

Percentage  all  deaths 

+  183 
—1.85 
+91 

+264 

—0.24 

+88 

—0.16 

—1.83 

+  128 
—3.36 
+63 
+  1.10 
—4.51 

+61 

—2.42 

+36 

+0.84 

—3.03 

—233 
—1.99 

July,  August,  and  September 

—70 

Percentage  year 

Percentage  all  deaths 

+  1.32 
+0.74 

+0.47 
—1.36 

It  will  be  seen  that  from  1907  through  1910  there  has  been  a  slowly  increasing 
gross  total  infant  mortality.  The  proportion  of  total  deaths  which  occurred  under 
one  year  of  age  was  higher  than  in  1907  during  the  three  years  following  it, 
although  it  has  slowly  fallen  each  year  after  1908.  The  year  1911,  however,  shows 
the  lowest  percentage  of  all  deaths  of  any  of  the  six  years,  being  even  lower  than 
1907. 

Comparing  the  summer  mortality,  the  total  has  slowly  increased,  but  not  in 


CAMPAIGNS  IN  OTHER  CITIES 


115 


proportion  to  the  population.  The  year  1911  shows  a  lower  total  than  1910,  but 
higher  than  the  four  previous  years.  The  percentage  of  the  year's  mortality 
which  occurred  during  these  three  months  is  also  higher  than  in  any  year  except 
1907.  In  other  words,  the  summer  mortality  is  not  reduced  quite  so  much  as  that 
for  the  rest  of  the  year.  The  percentage  of  all  deaths  occurring  during  the 
summer  months  is,  however,  lower  than  any  since  1906.  If  we  take  deaths  in 
1907,  the  low  year,  as  a  basis,  and  estimate  the  increase  on  the  same  basis  as 
increase  in  population,  the  mortality  should  have  been: 

TABLE  92.— MORTALITY  UNDER  ONE  YEAR  WHICH  SHOULD  HAVE  OCCURRED 
ON   BASIS   OF   1907   FIGURES,   COMPARED   WITH   ACTUAL   MORTALITY, 

DETROIT 


1908 

1909 

1910 

1911 

Estimated  mortality 

1698 
1734 
+36 

+2.1 

1799 
1801 

+2 

+0.1 

1900 

2095 

+  195 

+9.3 

2000 

Actual  mortality 

1862 

Difference 

— 138 

Per  cent,  difference 

—6.9 

Average  yearly  increase  in  population,  6.3  per  cent. 

Applying  the  same  method  to  the  summer  mortality  we  find  : 

TABLE  93.— MORTALITY  UNDER  ONE  YEAR  DURING  THREE  SUMMER  MONTHS 
WHICH  SHOULD   HAVE  OCCURRED  ON   BASIS  OF    1907  FIGURES,   COM- 
PARED WITH  ACTUAL  MORTALITY,  DETROIT 


1908 

1909 

1910 

1911 

Estimated  mortality 

584 
575 
—9 
—0.15 

619 

602 

—17 

—3.7 

654 
708 

+54 
+8.3 

688 

Actual  mortality 

638 

Difference 

Per  cent,  difference 

—50 
—7.3 

The  summer  reduction  has,  therefore,  kept  pace  with  the  yearly  reduction, 
allowing  for  increase  in  population.  The  infant  mortality  rate  also  shows  a  very 
marked  fall  to  139.2,  but  it  must  be  remembered  that  the  great  increase  in  births 
during  1910  and  1911  is  probably  partly  due  to  a  more  efficient  registration. 


Weather  Conditions 
Weather  conditions  in  Detroit  are  shown  in  Tables  94  and  95. 
The  most  striking  differences  occur  in  1909  and  1911.  August  was  hotter 
in  1909  than  in  either  1910  or  1911.  The  mean  for  the  month  was  higher,  and 
also  above  the  normal.  In  the  other  three  months  1911  was  in  excess  of  1909  by 
from  2°  to  3°.  Ninety-five  degrees  was  never  reached  in  1909,  while  it  was  reached 
three  times  in  1910  and  five  times  in  1911.  The  daily  mean  was  never  85°,  and 
only  80°  or  over  three  times  in  1909,  while  in  1911  it  was  85°  three  times  and  80° 
or  over  thirteen  times. 


ii6 


INFANT  MORTALITY  AND  MILK  STATIONS 


TABLE  94.— NUMBER  OF  DAYS  ON  WHICH  THE  MAXIMUM  AND  MEAN  TEM- 
PERATURE REACHED  CERTAIN  FIGURES,  DETROIT* 


1909 

June 

July 

August.  .  . 
September 

1910 

June 

July 

August.  .  . 
September 

1911 

June 

July 

August.  .  . 
September 


95°  or  + 


Maximum 


90°  or  + 


3 
3 
1 
0 

7 

3 
8 
1 
0 

12 


85°  or  + 


3 

5 
8 
2 

18 


15 
7 
0 

30 

6 
12 

7 
2 

27 


Mean 


85°  or  + 


80°  or  + 


3 
3 
1 
0 

7 

3 
8 
2 
0 

13 


TABLE   95.— MONTHLY   MEAN   TEMPERATURE,    RAINFALL,   AND    NUMBER  OF 

RAINY  DAYS,  DETROIT* 


Normal 

1909 

1910 

1911 

June 

Mean 

67.4° 
3.80  in. 

■ 

67° 
4.95  in. 
13 

66° 
1.47  in. 
9+0 

69° 

Rainfall 

Rainy  days 

July 

Mean 

Rainfall 

Rainy  days 

August 

Mean 

Rainfall 

Rainy  days 

September 

Mean 

1.48  in. 
9  +  7 

72.1° 
3.50  in. 

70.1° 
2.73  in. 

63.5° 
2.55  in. 

71° 
5.94  in. 
9+2 

72° 

3.75  in. 
9+5 

61° 
0.75  in. 
8+2 

74° 
1.48  in. 
6  +  5 

71° 
1.11  in. 

7+3 

63° 
2.02  in. 
10+2 

74° 

0.79  in. 
9+0 

71° 
1.31  in. 
9+6 

64° 

Rainfall 

Rainy  days 

4.32  in. 
14+4 

Totals 

Mean 

68.2° 
12.58  in. 

67.7° 
15.39  in. 
39+9 

68.5° 

6.08  in. 
32  +  10 

68.5° 

Rainfall 

Rainy  days 

7.9  in. 
41  +  17 

Note. — Two  figures  are  given  for  number  of  rainy  days — the  first,  in  front  of  the  plus  sign,  is 
the  number  of  days  precipitation  was  0.01  inch  or  more;  the  second,  after  the  plus  sign,  is  nuiU'- 
ber  of  days  there  was  a  trace  of  precipitation,  but  less  than  0.01  inch. 

*  Monthly  Meteorological  Summary,  Local  Weather  Bureau,  Detroit,  and  Monthly  Weather 
Review,  Washington. 


CAMPAIGNS  IN  OTHER  CITIES  117 

June,  1910,  was  cooler  than  1911  by  3°,  and  September  by  1°.  The  other 
two  months  had  the  same  mean,  1911  being  above  the  normal  in  all  four  months. 

Except  in  September  the  rainfall  in  1911  was  scanty,  being  well  below  the 
normal  in  each  month.  The  first  three  months  were  drier  than  in  1909.  July  was 
much  drier  than  1910,  and  had  very  slightly  greater  rainfall  in  June  and  August. 

It  is  in  the  months  of  July  and  August  that  the  greatest  reduction  in  infant 
deaths  occurred. 

The  Campaign 

Until  1910  very  little  was  done  in  Detroit  for  preventing  infant  mortality 
outside  of  the  ordinary  relief  work  done  by  charitable  organizations.  The  Babies' 
Milk  Fund  distributed  good  milk,  whole  or  modified,  to  patients  referred  by  the 
various  clinics  and  hospitals.  No  attempt  was  made  to  follow  up  these  babies, 
nor  was  any  home  instruction  given. 

In  1910  the  Health  Department  began  a  "mothers'  clinic"  under  the  charge 
of  Dr.  Duffield.  The  Visiting  Nurses'  Association  assigned  one  nurse  to  this 
clinic,  which  attempted  to  secure  proper  feeding  for  babies  and  instruction  for 
their  mothers.  The  milk  was  distributed  unmodified,  and  was  prepared  at 
home  under  supervision. 

The  "Children's  Bureau"  was  organized  this  same  year,  composed  of  repre- 
sentatives of  18  different  organizations;  a  trained  social  worker  was  employed, 
and  cooperation  and  greater  efficiency  resulted. 

In  1911  the  Babies'  Milk  Fund  started  two  milk  stations  in  charge  of  a  Med- 
ical Director,  Dr.  Cooley,  with  nurses  in  attendance.  The  Milk  Fund  gave  up  the 
modification  of  milk  except  in  very  exceptional  cases,  teaching  home  modification 
instead.  Home  visiting  by  the  nurses  is  made  a  great  feature  of  the  work,  and 
cooperation  exists  with  the  Visiting  Nurses'  Association.  Consultations  are  held 
at  the  stations,  attendance  by  the  mothers  being  demanded.  Classes  have  been 
started  for  mothers  and  young  girls  in  infant  hygiene,  making  of  clothes,  etc. 
Obstetric  clinics  are  being  started  in  connection  with  the  stations,  and  promise 
to  be  valuable  additions  to  the  work. 

The  Mothers'  Clinic  of  the  Health  Department  increased  its  activities  very 
largely  in  1911.  The  school  nurses  were  detailed  to  its  work  in  the  summer 
months.     Births  reported  by  midwives  were  visited,  and  the  mother  instructed. 

A  campaign  of  publicity  was  started  to  try  to  improve  the  milk  supply.  A 
milk  exhibit  was  held  under  the  auspices  of  the  Board  of  Commerce  and  the 
Health  Department,  which  resulted  in  greatly  improving  the  supply  through  the 
raising  of  the  standards  required. 

A  considerable  amount  of  work  has  been  done,  and  very  nearly  all  of  it  dur- 
ing the  years  1910  and  1911.  The  educational  prevention  of  infant  mortality  is 
being  emphasized. 


Ii8 


INFANT  MORTALITY  AND  MILK  STATIONS 


BUFFALO 

The  mortality  under  one  year  for  Buffalo  is  shown  in  the  following  table: 
TABLE  96.— MORTALITY  UNDER  ONE  YEAR,  BUFFALO* 


I 


January 

February 

March 

April 

May 

June 

July 

August 

September 

October 

November 

December 

Year 

Percentage  all  deaths 

July,  August,  and  September 

Percentage  of  year 

Percentage  all  deaths 

Births 

Infant  mortality  rate 


1906 


84 

85 

92 

97 

80 

77 

130 

221 

67 

99 

93 

121 


1246 
19.6 


418 
33.5 
23.7 


8075 
154.3 


1907 


39 

118 

114 

109 

100 

79 

290 

242 

152 

92 

73 

87 


1495 
33.5 


684 
45.7 

38.8 


8891 
168.1 


1908 


107 

110 

96 

100 

77 

73 

154 

174 

141 

144 

77 

74 


1317 
31.1 


469 
35.6 
39.9 


9171 
143.6 


1909 


110 
101 

77 

70 

89 

64 

136 

192 

117 

98 

85 

114 


1253 
19.8 


445 
35.5 
37.5 


9027 
138.8 


1910 


109 

76 

111 

135 

123 

67 

139 

254 

173 

109 

91 

95 


1482 
31.3 


566 
38.3 
33.0 


10,008 
148.1 


Average 
1906-10 


90 

96 

98 

103 

94 

73 

170 

316 

130 

108 

84 


1358 

20.9 


516 

38.0 
30.5 


9373 
146.5 


1911 


96 
82 
94 
97 
88 

104 
97 

103 
90 
70 
63 
66 


1050 
30.7 


290 
37.6 
30.0 


10,546 
99.5 


The  difference  between  1911  and  the  other  years  is  shown  in  the  following 
table : 

TABLE  97.— DIFFERENCE  BETWEEN  MORTALITY  UNDER  ONE  YEAR  IN  1911  AND 

PREVIOUS  YEARS,  BUFFALO 

1910 


Year 

Percentage  all  deaths 

July,  August,  and  September 

Percentage  of  year's  infant  mortality 
Percentage  all  deaths 

Infant  mortality  rate 


1906 

1907 

1908 

1909 

—196 

—445 

—267 

—203 

+  1.1 

—1.8 

—0.4 

+0.9 

—128 

—394 

—179 

—155 

—5.9 

—18.1 

—8.0 

—7.9 

—3.7 

—13.8 

—9.9 

—7.5 

—54.8 

—67.6 

—44.1 

—39.3 

—432 

—0.6 

—276 

—10.6 

—12.0 

—48.6 


It  will  be  seen  at  once  that  there  was  a  most  phenomenal  decrease  in  the 
infant  mortality  in  1911.  Only  January  and  June  are  above  the  five-year  aver- 
age. The  decrease  is  all  in  the  second  half  of  the  year.  The  figures  for  the  first 
and  second  half-years  are: 

*  These  figures  are  taken  from  the  monthly  bulletin  of  the  State  Department  of  Health. 
They  will  be  found  to  differ  considerably  in  some  cases  from  the  Census  Bureau  figures,  and  from 
those  of  the  Buffalo  Department  of  Health  Annual  Reports,  owing  apparently  to  different  methods 
in  tabulating  still-births. 


CAMPAIGNS  IN  OTHER  CITIES  119 

TABLE  98.— MORTALITY  UNDER  ONE  YEAR  BY  HALF-YEARLY  PERIODS,  BUFFALO 


1906 

1907 

1908 

1909 

1910 

Average 
1906-10 

1911 

First  half-year 

515 
731 

559 
936 

553 
764 

511 
742 

621 
861 

553 

806 

561 
489 

Second  half-year 

The  striking  situation  exists  of  the  second  half  of  the  year  having  a  lower 
mortality  than  the  first  half ;  even  more  striking  are  the  figures  by  trimesters : 

TABLE  99.— MORTALITY  UNDER  ONE  YEAR  BY  TRIMESTERS,  BUFFALO 


First  trimester. . 
Second  trimester 
Third  trimester . 
Fourth  trimester 


1906 


261 
254 
418 
313 


1907 


271 
288 
684 

252 


1908 


303 
250 
469 
295 


1909 


288 
223 
445 
297 


1910 


296 
325 
566 
295 


Average 
1906-10 


384 
368 
516 
390 


1911 


272 
289 
290 
199 


The  percentages  of  the  year's  total  deaths  occurring  in  each  of  the  four 
trimesters  in  1911,  as  compared  with  the  average  for  five  years,  are: 


TABLE  100.- 

-MORTALITY  UNDER  ONE  YEAR   BY  TRIMESTERS, 
AGES,  BUFFALO 

IN  PERCENT- 

First 

Second 

Third 

FOURTH 

1911 

25.91 
30.91 

27.52 
19.73 

27.62 
38.00 

18.95 

Average 

31.36 

A  difference  of  one-tenth  of  1  per  cent,  is  shown  between  the  second  and  third 
quarters  in  1911,  as  against  18.27  in  the  average.  The  third  quarter  in  1911  is 
10.38  less  than  the  average. 

The  percentage  of  all  deaths  for  the  year,  however,  is  only  0.6  lower  than 
1910,  and  is  1.1  per  cent,  higher  than  1906.  For  the  summer  months  it  is  12  per 
cent,  lower  than  1910,  and  3.7  per  cent,  lower  than  1906. 

The  infant  mortality  rate  is  from  39.3  to  67.6  lower  than  the  pre- 
ceding years,  being  99.5,  a  very  low  figure. 

If  we  estimate  the  deaths  that  would  have  occurred  if  the  mortality  had  in- 
creased at  the  same  rate  as  the  population,  based  on  the  figures  of  1906,  the  low 
year,  we  find: 

TABLE  101.— YEAR'S  MORTALITY  UNDER  ONE  YEAR  WHICH  SHOULD  HAVE  OC- 
CURRED,  BASED   ON   1906  FIGURES,   COMPARED   WITH   ACTUAL   MOR- 
TALITY, BUFFALO 


1907 

1908 

1909 

1910 

1911 

Estimated  mortality 

1271 
1495 

+224 
+  17.6 

1296 
1317 
+21 
+  1.6 

1321 
1253 
—68 
—3.1 

1347 

1482 

+  135 

+  10.0 

1372 

Actual 

1050 

Difference 

—322 

Percentage  difference 

—23.5 

Average  yearly  increase  in  population,  2.02  per  cent. 


120  INFANT  MORTALITY  AND  MILK  STATIONS 

Estimating  in  the  same  way  the  summer  mortality  we  find: 

TABLE  102.— MORTALITY  UNDER  ONE  YEAR,  DURING  THREE  SUMMER  MONTHS, 
WHICH  SHOULD  HAVE  OCCURRED,  BASED  ON  1906  FIGURES,  COM- 
PARED WITH  ACTUAL  MORTALITY,  BUFFALO 


1907 

1908 

1909 

1910 

1911 

426 

684 

+258 

+60.6 

435 
469 

+34 
+7.8 

443 
445 
+2 
+0.5 

452 

566 

+  114 

+35.3 

460 

290 

—170 

—36.9 

There  has  been  a  most  phenomenal  decrease  in  infant  deaths  in  Buffalo. 
The  infant  mortality  rate  has  fallen  to  99.5,  and  the  actual  figures  for  births  are 
only  546  more  than  1910,  so  that  there  cannot  have  been  a  very  greatly  increased 
reporting  of  births,  in  all  probability. 


Weather  Conditions 
Weather  conditions  in  Buffalo  are  shown  in  the  following  tables: 

TABLE  103.— NUMBER  OF  DAYS  ON  WHICH  MAXIMUM  AND   MEAN  TEMPERA 
TURES  REACHED  CERTAIN  FIGURES,  BUFFALO* 


Maximum  Temperature 

Mean  Temperature 

95°  or  + 

90"  or  + 

85°  or  + 

80°  or  + 

85°  or  + 

80°  or  + 

75°  or  + 

1909 

June 

July 

August 

September  .  . 

0 
0 
0 
0 

0 
0 
0 
0 

1 

0 
2 

1 

2 
7 

10 
3 

0 
0 
0 
0 

0 
0 
0 
0 

1 

3 
6 

1 

Total  . . 

1910 

June 

July 

August 

September  .  . 

0 

0 
0 
0 
0 

0 

0 
0 
0 
0 

4 

1 
2 
5 
0 

22 

6 
9 

12 

0 

0 

0 
0 
0 
0 

0 

0 
0 
0 
0 

11 

1 
3 
7 
0 

Total  . . 

1911 

June 

July 

August 

September  .  . 

0 

0 
1 
0 
0 

0 

0 
2 
2 
0 

8 

0 
6 
6 
0 

27 

2 
11 
11 

1 

0 
0 

1 

0 
0 

0 

0 

3 
3 
0 

11 

0 

10 

9 

0 

Total  . . 

1 

4 

12 

25 

1 

6 

19 

*  Monthly  Meteorological  Summary,  Buffalo,  and  Weather  Review,  Washington,  D.  C. 


CAMPAIGNS  IN  OTHER  CITIES 


121 


TABLE  104.— MONTHLY   MEAN    TEMPERATURE,  RAINFALL,  AND   NUMBER  OF 

RAINY  DAYS,  BUFFALO* 


Normal 

1909 

1910 

1911 

June 

Mean 

65° 
3.03  in. 

70° 
3.33  in. 

69° 
2.95  in. 

63° 
3.09  in. 

66.7° 
12.39  in. 

64.6° 
1.05  in. 

5  +  7 

68.6° 
2.49  in. 
10+3 

69.4° 
1.69  in. 

8 

61.7° 
2.61  in. 

11+4 

66.07° 

7.84  in. 
34+14 

62.8° 
1.05  in. 

8+5 

70.1° 
5.33  in. 

8+4 

69.4° 
2.72  in. 
8+3 

62.0° 
2.16  in. 
10+4 

66.07° 
11.26  in. 
34+16 

66.3° 

2.23  in. 
12  +  6 

71.6° 
4.41  in. 

8  +  7 

69.8° 
4.61  in. 

11+4 

62  2° 

Rainfall 

Rainy  days 

Mean 

Rainfall 

Rainy  days 

August 

Mean 

Rainfall 

Rainy  days 

September 

Mean 

Rainfall 

Rainy  days 

Total 

j^          Mean 

3.81  in. 
11+6 

67  4° 

P      Rainfall 

*        Rainy  days 

15.06  in. 
42+23 

Note. — Two  figures  are  given  for  number  of  rainy  days — the  first,  in  front  of  the  plus  sign,  is 
the  number  of  days  precipitation  was  0.01  inch  or  more;  the  second,  after  the  plus  sign,  is  number 
of  days  there  was  a  trace  of  precipitation,  but  less  than  0.01  inch. 

Temperatures  above  90°  are  unusual  in  Buffalo.  They  were  not  recorded 
during  the  years  1909  and  1910.  Figures  for  a  maximum  of  80°  and  a  mean  of 
75°  are,  therefore,  included  in  the  table. 

The  year  1911,  therefore,  stands  out  as  a  year  when  there  were  periods  of 
extreme  heat,  90°  or  more  being  recorded  on  two  days  in  both  July  and  August. 
A  mean  temperature  of  80°  or  more  was  also  recorded  in  both  July  and  August, 
which  did  not  occur  in  either  1909  or  1910.  A  mean  temperature  of  75°  was 
reached  nineteen  times  in  1911  as  against  eleven  times  in  the  two  previous  years. 
The  monthly  means  show  1911  above  the  normal  in  each  month  except  Septem- 
ber, and  higher  than  either  1909  or  1910  for  each  month. 

The  rainfall  except  in  June  was  above  the  normal  in  each  month,  and  was 
greater  than  the  corresponding  months  in  1909  and  1910,  except  in  July,  when 
less  rain  fell  than  in  1910. 

Except  in  rainfall,  weather  conditions  were  unfavorable  for  a  low  infant 
mortality. 

The  Campaign 

It  has  been  difificult  to  obtain  exact  information  in  regard  to  the  activities 
being  carried  on  in  Buffalo.  In  a  general  way  everybody  seems  to  be  agreed 
that  during  the  last  year  some  very  active  work  has  been  done  by  the  Health  De- 
partment and  social  organizations.  The  problem  of  the  milk  supply  is  being  very 
actively  handled  by  the  Health  Commissioner,  Dr.  Fronczak.  The  Children's 
Welfare  Society  and  the  Babies'  Milk  Dispensary  are  both  very  active  in  their 
campaign.  Considerable  cooperation  exists  between  the  various  agencies,  and 
the  Health  Department  is  doing  all  in  its  power  to  increase  this  cooperation. 
*  Monthly  Meteorological  Summary,  Buffalo,  and  Weather  Review,  Washington,  D.  C. 


I 


CHAPTER  VII 

General  Summary 

For  convenience  in  reference  the  mortality  in  the  various  localities  studied 
is  summarized  in  the  following  tables. 

Table  105  shows  the  highest,  lowest,  and  difference  between  same,  for  the  years 
1906-10  inclusive,  in  the  year's  actual  mortality  under  one  year;  the  percentage 
of  all  deaths,  and  the  infantile  mortality  rate;  the  actual  deaths,  percentage  of  all 
deaths,  and  proportion  occurring  in  this  period  for  the  third  quarter;  and  the 
relation  of  the  1911  figures  to  the  highest,  lowest,  and  1910  figures  in  each  of  \ 
these  groups.  ^ 

Table  106  shows  the  same  thing  expressed  in  percentages.     By  "Extremes" 
is  meant  the  difference  between  highest  and  lowest  in  the  period    1906-10  ex-  i 
pressed  in  percentage  of  the  highest.     The  yearly  average  increase  in  population  " 
is  also  noted. 

A  consideration  of  these  tables  shows  that: 

1.  In  actual  yearly  deaths — 

Manhattan,  Brooklyn,  City  of  New  York,  Philadelphia,  St.  Louis, 
Baltimore,  and  Buffalo  show  a  decrease  in  1911  from  the  lowest 
actual  mortality  recorded  in  the  previous  five-year  period. 

In  the  amount  of  this  decrease  from  lowest  figures,  expressed  in 
percentages,  the  figures  for  Manhattan  are  exceeded  only  by  j 
Baltimore  and  Buffalo. 

"Rest  of  City,"  Chicago,  Boston,  Cleveland,  Pittsburgh,  and  De- 
troit show  an  increase  in  1911  from  this  lowest  figure. 

2.  In  the  ratio  of  infant  deaths  to  total  deaths  for  the  year,  in  1911 — 

All  but  Buffalo  show  a  decrease  from  the  lowest  figure  recorded. 

In  actual  figures  the  proportion  of  decrease  is  greater  in  Manhattan  i 
than  in  any  of  the  other  localities  except  Cleveland,  Pitts- 
burgh, and  Detroit. 

In  the  percentage  decrease  from  the  lowest  previous  figure,  Man- 
hattan is  exceeded  only  by  Philadelphia  and  Cleveland  (8.8 
and  8.6  respectively,  as  against  7.8  for  Manhattan). 

3.  In  infant  mortality  rate  for  1911 — 

Manhattan  is  higher  than  any  other  city  in  actual  figures  except 
Boston,  Cleveland,  and  Detroit.  ! 

A  decrease  from  the  lowest  previous  rate  is  noted  in  all  except  \ 
Boston,  which  is  6.2  higher  than  its  lowest  previous  figure,  and 
Cleveland,  which  is  11.4  higher.  These  figures,  however,  are 
of  little  real  value  in  most  cases,  as  birth  registration  has  only 
within  the  last  year  or  two  received  any  attention  from  the 
authorities. 

122 


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125 


126  INFANT  MORTALITY  AND  MILK  STATIONS 

The  percentage  decrease  in  Manhattan  is  the  smallest  of  any  which 
show  a  decrease.  The  real  value  of  this  is  also  small,  as  stated 
above. 

4.  In  actual  deaths  during  the  third  quarter  of  the  year  1911 — 

Manhattan,  Brooklyn,  New  York  City,  Chicago,  Philadelphia,  St. 

Louis,  Baltimore,  and  Buffalo  show  a  decrease  from  the  lowest 

previous  year. 
"Rest  of  City,"  Boston,  Cleveland,  Pittsburgh,  and  Detroit  show 

an  increase  from  the  lowest  previous  figure. 
Manhattan  shows  a  greater  percentage  of  decrease  from  the  lowest 

previous  figures  than  any  locality  except  Brooklyn  and  Buffalo. 

5.  In  ratio  of  infant  deaths  to  total  deaths  occurring  in  third  quarter 

of  1911— 

There  is  a  decrease  from  the  lowest  previous  figures  in  all  save 
Chicago,  Baltimore,  and  Detroit. 

In  actual  decrease  from  lowest  previous  figure  Manhattan  is  ex- 
ceeded only  by  Cleveland,  Baltimore,  Pittsburgh,  and  Detroit. 

Manhattan  shows  the  greatest  percentage  decrease  from  lowest 
previous  figure — 17.1  per  cent,  as  against  15.6  per  cent,  for 
Buffalo. 

6.  In  percentage  of  year's  infant  mortality  occurring  in  third  quarter  of 

1911— 

There  is  a  reduction  from  the  lowest  previous  figures  in  Manhattan, 
Brooklyn,  "Rest  of  City,"  New  York  city,  Chicago,  Phila- 
delphia, and  Buffalo. 

An  increase  is  noted  in  St.  Louis,  Boston,  Cleveland,  Baltimore, 
Pittsburgh,  and  Detroit. 

Manhattan  shows  the  lowest  actual  figure  of  any  locality  except 
Buffalo — 28  as  against  27.6  per  cent. 

The  percentage  of  decrease  from  lowest  previous  figure  in  Man- 
hattan is  exceeded  only  by  Brooklyn  and  Buffalo. 

7.  Leaving  out  of  consideration  the  infant  mortality  rate  which  is  ab- 

solutely unreliable  for  comparative  study  over  a  period  of 
years — 

Manhattan  shows  a  greater  percentage  reduction  than  Chicago, 
St.  Louis,  Boston,  Pittsburgh,  and  Detroit  in  every  respect. 
Philadelphia  and  Cleveland  have  a  better  showing  only  in  the 
ratio  of  infant  deaths  to  total  deaths  for  the  year.  Baltimore 
exceeds  only  in  the  percentage  decrease  of  actual  deaths  for 
the  year. 

Buffalo  has  a  better  showing  in  each  respect  except  in  the  ratio  of 
infant  deaths  to  total  deaths  for  the  year  and  for  the  third 
trimester. 

The  percentage  reduction  in  mortality  for  the  third  trimester  is 
greater  in  Manhattan  than  in  any  other  region  studied.  Com- 
pared with  the  "Rest  of  the  City,"  Manhattan  makes  a  better 
showing  in  reduction  in  every  point. 

There  is  still  another  method  of  estimating  results  based  upon  the  method 
of  comparison  with  previous  low  records,  allowing  for  increase  of  population. 
The  following  tables  are  constructed  to  put  the  1911  mortality  figures  to  as  severe 
a  test  as  possible. 


GENERAL  SUMMARY 


127 


Taking  the  low  record  total  for  the  year  in  each  city  and  allowing  for  increase 
in  population,  we  have  the  following: 

TABLE  107.— MORTALITY  UNDER  ONE  YEAR  WHICH  SHOULD  HAVE  OCCURRED 
IN   1911,   BASED  ON   LOW  FIGURE  PREVIOUS  TO   1910,  ALLOWING  FOR 
INCREASE   IN   POPULATION,    COMPARED   WITH   ACTUAL   MOR- 
TALITY IN  1911  IN  VARIOUS  LOCALITIES 


Buffalo. 

St.  Louis 

Baltimore.  .  .  . 
Philadelphia.  . 

Chicago 

Detroit 

Pittsburgh .  . .  . 
Cleveland .... 

Boston 

Brooklyn 

"Rest  of  City" 
New  York  City 
Manhattan .  . . . 


Lowest 

Previous 

Year's 

Total 


1246 
1715 
2215 
4597 
6114 
1598 
1804 
1711 
2125 
4601 
1631 
14413 
81S4 


Year 


1906 
1907 
1908 
1903 
1906 
1907 
1907 
1909 
1909 
1903 
1903 
1903 
1903 


Increase 
IN  Popu- 
lation 


10.10 

7.76 

2.91 

15.76 

14.35 

25.20 

7.28 

9.38 

3.92 

32.08 

72.30 

28.56 

30.81 


Estimated 
Mortality 


1371 
1848 
2279 
5321 
6991 
2000 
1935 
1871 
2208 
6077 
2810 
18529 
9SS4 


Mortality, 
1911 


1050 
1579 
1958 
4616 
6309 
1862 
1810 
1788 
2245 
4629 
2196 
15017 
8912 


Difference 


—  321 

—  269 

—  321 

—  705 

—  682 

—  138 

—  125 

—  83 
+  37 
—1448 

—  614 
—3512 
—1693 


Per  Cent. 
Difference 


—23.5 
—14.5 
—14.0 
—13.2 
—10.1 

—  6.9 

—  6.4 

—  4.4 
+  1.7 
—23.8 
—21.8 
—20.4 
—17.1 


Of  the  first  nine  cities  in  the  list,  Buffalo  alone  has  a  greater  reduction  from 
this  estimated  mortality  than  Manhattan.  Brooklyn,  the  "Rest  of  the  City," 
and  New  York  as  a  whole  had  a  greater  reduction  than  Manhattan. 

If,  now,  we  compare  the  mortality  during  the  three  summer  months  in  the 
same  way,  we  see  the  following  results: 

TABLE  108.— MORTALITY  UNDER  ONE  YEAR  WHICH  SHOULD  HAVE  OCCURRED 

DURING  THE  THREE  SUMMER  MONTHS  OF  1911,  BASED  ON  PREVIOUS  LOW 

FIGURES,  AND  ALLOWING  FOR  INCREASE  IN  POPULATION,  COMPARED 

WITH  ACTUAL  MORTALITY  IN  1911  IN  VARIOUS  LOCALITIES 


Buffalo 

Chicago 

Detroit 

Philadelphia.  .  .  . 

Cleveland 

Baltimore 

St.  Louis 

Pittsburgh 

Boston 

Brooklyn 

City  of  New  York 
"Rest  of  City"  .  . 
Manhattan 


Estimated 
Mortality 


502 

2198 

719 

1709 

606 

759 

740 

600 

770 

2185 

6576 

1120 

2787 


Mortality 
in  1911 


290 

1904 

638 

1537 

569 

716 

699 

591 

764 

1499 

4593 

800 

2294 


Difference 


-  312 

-  294 

-  81 

-  172 

-  37 

-  43 

-  41 

-  9 

-  6 

-  686 
-1983 

-  320 

-  493 


Per  Cent. 
Difference 


—63.9 
—13.4 
—11.3 
—10.1 

—  6.1 

—  5.7 

—  5.5 

—  1.5 

—  0.8 
—31.4 
—30.1 
—28.6 
—17.9 


From  this  estimated  summer  mortality,  Buffalo  again  alone  has  a  greater 
percentage  difference  than  Manhattan,  except  for  the  city  of  New  York  as  a 


128 


INFANT  MORTALITY  AND  MILK  STATIONS 


whole,  Brooklyn,  and  the  "Rest  of  the  City."     It  is  this  summer  mortality  which 
has  been  most  influenced  by  the  campaign  against  infant  mortality. 

Another  even  more  severe  test  of  results  may  be  applied.  If  we  take  the 
lowest  recorded  proportion  of  the  year's  deaths  occurring  in  the  third  quarter  and 
apply  it  to  the  lowest  year's  total,  we  should  in  most  cases  have  still  lower  figures 
for  a  basis.  For  example  in  1903  in  Manhattan  the  year's  total  under  one  year 
was  8181,  the  lowest  recorded  in  the  ten-year  period  1901-1910.  In  1909  the  pro- 
portion of  the  year's  mortality  falling  in  the  third  quarter  was  29.6,  the  lowest 
recorded.  Taking  then  29.6  per  cent,  of  8181,  we  get  the  optimum  figures  for 
comparison.     The  following  table  shows  these  figures : 

TABLE    109.— INFANT   MORTALITY   IN    THE    THIRD    QUARTER   OF    1911    COM- 
PARED WITH  ESTIMATED  MORTALITY  BASED  ON  OPTIMUM 
FIGURES  FOR  PERCENTAGE  OF  YEAR'S  MORTALITY 
AND  TOTAL  YEAR'S  MORTALITY 


Buffalo 

Philadelphia.  . 

Chicago 

Baltimore.  .  .  . 

Detroit 

Cleveland.  .  .  . 
Pittsburgh .  .  .  . 

St.  Louis 

Boston 

Brooklyn 

New  York  City 
"Rest  of  City" 
Manhattan .  .  .  . 


Estimated 

1911 

Mortality 

Mortality 

459 

290 

1793 

1537 

2146 

1904 

797 

716 

652 

638 

576 

569 

565 

591 

583 

699 

470 

764 

2120 

1499 

6096 

4593 

1025 

800 

%n5 

2394 

Difference 


+ 


179 
256 

242 
81 
14 

7 
26 


-f-  116 
-+-  294 

—  621 
—1503 

—  225 

—  631 


Per  Cent. 
Difference 


—39.0 
—14.3 
—11.3 
—10.2 

—  2.1 

—  1.2 
+  4.6 
-f-19.8 
+62.5 
—29.2 
—24.6 
—21.9 
—31.5 


Only  six  of  the  cities  outside  of  New  York  can  show  a  decrease;  Pittsburgh, 
St.  Louis,  and  Boston  show  an  increase — Boston,  of  62.5  per  cent.  Manhattan 
again  exceeds  all  but  Buffalo,  which  again  ranks  first. 

A  study  of  charts  shown  in  Exhibits  3  to  7,  comparing  daily  deaths  with 
temperatures  in  Manhattan  and  Brooklyn,  is  of  interest  in  connection  with 
the  theories  of  Liefmann  and  Lindemann,  as  mentioned  in  Chapter  I.  Their 
theory  is  that  the  summer  mortality  among  babies  is  due  to  two  chief  causes. 
The  first  of  these  is  the  directly  fatal  effect  of  high  atmospheric  temperature, 
which  results  in  sharp  rises  in  the  mortality  curve  following  twenty-four  to 
forty-eight  hours  after  the  rise  in  temperature.  These  rises,  followed  by  sharp 
falls  to  the  "normal,"  occur  chiefly  in  early  summer.  In  late  summer  another 
factor  is  added.  The  basal  line,  so  to  speak,  is  continually  high,  and  represents 
practically  the  diarrheal  deaths.  On  this  basal  curve  occur  the  rapid  rises  and 
falls  in  the  mortality  curve  immediately  following  hot  periods. 

These  conditions  are  very  plainly  seen  in  plates  showing  the  temperature  and 
mortality  in  Manhattan  in  1909  and  1910  and  Brooklyn  in  1910.  In  1911,  how- 
ever, the  mortality  curve  is  a  very  different  one.  Sharp  rises  and  falls  do  occur, 
but  the  diarrheal  element  is  markedly  diminished.     Heat  deaths  occur,  but  the 


GENERAL  SUMMARY  129 

high  basal  line  representing  diarrhea  is  down  nearer  the  normal.  Also  the  sharp 
rises  are  not  so  great,  which  tends  to  show  the  absence  of  the  predisposing  element 
resulting  in  great  susceptibility  to  high  temperature. 

Briefly  summarizing  weather  conditions  in  1911  in  a  general  way,  temperature 
was  decidedly  unfavorable  for  a  low  infant  mortality  throughout  the  country  in 
July  and  early  August.  In  St.  Louis  heat  was  excessive  and  continued  through- 
out the  summer.  Detroit  and  Buffalo  especially  are  unused  to  such  temperatures 
as  occurred  in  1911. 

Rainfall  was  not  so  uniformly  unfavorable  as  temperature.  In  Chicago, 
Philadelphia,  and  Baltimore,  while  below  the  normal,  it  was  not  nearly  so  scanty 
as  in  other  places.  In  Boston  and  Buffalo  it  was  above  the  normal.  In  New  York 
and  the  other  cities  studied  it  was  very  scanty  during  July  and  early  August, 
especially  in  St.  Louis. 

It  is  rather  difficult  to  gage  the  activities  of  health  departments  and  private 
organizations.  In  a  general  way  all  the  cities  discussed,  except  Boston,  were  more 
active  in  191 1  than  ever  before.  In  Greater  New  York,  Manhattan  and  Brooklyn 
were  very  decidedly  more  active.  Never  in  their  history  has  so  great  and  general 
an  effort  been  put  forth,  and  these  boroughs  were  fairly  well  cared  for.  Chicago 
and  Philadelphia  profited  by  previous  experience,  and  their  campaigns  were  more 
efficient  and  extensive.  St.  Louis  also  extended  its  campaign,  as  did  Detroit. 
Baltimore  added  home  instruction  as  an  important  feature  of  its  work. 

Buffalo  made  the  most  remarkable  showing  of  any  city  studied.  The  Health 
Department  had  begun  a  vigorous  campaign  for  pure  milk,  and  the  milk  stations 
of  the  Babies'  Milk  Dispensary  were  active. 

Boston  is  the  striking  exception  to  the  general  rule  of  reduction.  Consider- 
able effort  has  been  made  to  find  out  conditions  existing  there  in  1911,  and  ap- 
parently there  has  been  absolutely  no  increase  in  effort  nor  expansion  of  the  work 
over  past  years.  The  weather  conditions  were  no  worse  comparatively  than  in 
other  places,  and  in  rainfall  they  were  better  than  most  others.  With  these  condi- 
tions went  a  stationary  infant  mortality  compared  with  1910,  and  a  poorer  show- 
ing compared  with  previous  years  than  most  of  the  other  cities  record. 

CONCLUSIONS 

From  the  information  gained  through  experience  and  study  of  the  work  of 
reducing  infant  mortality  the  following  conclusions  seem  to  be  justified: 

1.  The  reduction  of  infant  mortality  in  1911  in  the  cities  studied  was 
very  marked,  especially  during  the  summer  months.  During  the  first  part  of  the 
summer  meteorological  conditions  was  not  favorable  to  a  low  mortality. 

2.  This  reduction  was  not  due  to  chance,  but  bears  a  close  relation  to  the 
activity  of  the  campaign  for  the  reduction  of  infant  mortality.  The  difference 
between  cities  in  infant  mortality  rates  is  probably  more  a  matter  of  public  con- 
science and  quaHty  of  official  endeavor,  than  weather  and  character  of  population. 

3.  The  full  effects  of  any  campaign  will  not  be  seen  immediately.  Dr. 
Robertson,  Health  Officer  of  Birmingham,  England,  said  at  the  conference  at 
Caxton  Hall  that  he  would  be  satisfied  if  he  got  results  after  ten  years'  work. 

9 


130  INFANT  MORTALITY  AND  MILK  STATIONS 

4.  In  the  education  of  the  mother  in  the  care  of  herself  and  her  baby  we 
have  the  strongest  weapon  for  fighting  infant  mortality. 

5.  The  results  in  the  milk  stations,  as  shown  by  the  detailed  histories  of  3182 
babies,  has  proved  the  usefulness  of  the  milk  station  in  the  reduction  of  infant 
mortality.  It  is  one  of  the  most  efficient  forces  in  the  educational  prevention  of 
sickness  and  deaths  among  babies. 

6.  Its  field  of  usefulness  can  be  very  greatly  extended  into  other  branches 
of  infant  and  child  welfare,  such  as  prenatal  work;  the  care  of  children  under 
school  age;  follow-up  work  in  inspection  of  school-children;  supervision  of 
boarded-out  babies  and  midwives,  etc.  Stations  should  be  maintained  all  the 
year  round  in  order  to  make  their  value  cumulative. 

7.  The  sphere  of  influence  of  a  milk  station  is  limited,  so  that  many  are 
needed  in  a  large  city. 

8.  One  nurse  for  every  100  babies  is  the  limit  for  the  maximum  of  efficiency, 
and  probably  300  babies  the  limit  for  any  one  station. 

9.  Compulsory  attendance  under  penalty  of  stopping  milk  supply  should 
be  insisted  on. 

10.  When  efficiently  managed,  the  milk  station  is  an  economical  means  of 
forwarding  the  movement  for  infant  welfare. 

11.  The  results  of  the  methods  employed  at  the  Committee's  milk  stations 
prove  conclusively  the  entire  feasibility  of  teaching  home  modification  of  milk, 
thus  not  only  doing  away  with  expensive  laboratory  plants,  but  making  the 
mother  eventually  independent  of  the  station. 

12.  The  milk  station  can  and  should  be  a  valuable  means  of  encouraging  and 
making  possible  maternal  nursing.  It  need  not  be  an  encouragement  to  artificial 
feeding. 

13.  Private  agencies  are  warranted  in  initiating  milk  station  work,  but  their 
program  should  provide  for  having  the  municipality  assume  charge  as  soon  as 
practical.  The  activities  which  are  possible  for  the  stations  are  proper  functions 
for  the  municipality.  Close  cooperation  between  health  authorities  and  private 
organizations  is  entirely  feasible  and  necessary. 

14.  The  education  of  the  "little  mothers"  in  the  care  of  the  baby  will  insure 
not  only  immediate  results,  but  will  pave  the  way  for  better  motherhood. 


CHAPTER  VIII 

Extension  of  Relief  Through  Milk  Stations 

Because  ignorance,  poverty,  squalor,  and  sickness  in  the  home  lessen  the  chance 
of  the  baby  to  survive  a  heated  summer,  it  is  obvious  that  a  well-organized  cam- 
paign to  reduce  infant  mortality  must  provide  ways  and  means  for  doing  a  great 
deal  more  than  giving  advice  in  the  homes  where  these  conditions  exist.  If  the 
campaign  is  confined  to  babies  living  under  average  home  conditions  with  mothers 
anxious  for  instruction,  only  a  moderate  reduction  in  the  death-rate  can  be  ex- 
pected, because  it  is  not  the  baby  in  the  average  home  who  is  most  likely  to 
die.  The  mother  who  comes  to  a  milk  station  of  her  own  accord  with  the  well  baby 
to  learn  how  to  keep  it  well  is  not  the  mother  most  likely  to  lose  her  baby.  The 
mother  most  needing  the  influence  of  the  milk  station  is  the  one  with  whom  the 
nurse  has  to  work  hard  to  have  her  baby  enrolled  because  of  ignorance  and  bad  home 
conditions.  When  these  mothers  are  visited,  the  station  nurse  must  be  prepared  to 
solve  the  problem  of  the  home ;  she  must  be  able  to  suggest  the  proper  solution  for 
each  problem  presented  to  her.  To  do  this,  the  nurse  must  know  the  facilities 
available,  be  they  private  or  public,  and  act.  If  she  acts  wisely,  she  gains  the 
mother's  confidence  and  cooperation  in  giving  the  baby  a  chance  to  live;  visits 
and  advice  where  substantial  relief  is  needed  avail  nothing  if  the  relief  is  not  to  be 
obtained.  If  the  father  needs  hospital  care,  it  must  be  provided;  if  out  of  work, 
he  must  be  brought  in  touch  with  the  proper  agency  dealing  with  such  cases ;  if 
the  children  are  undernourished  and  sickly,  an  agency  prepared  to  provide  the 
necessities  must  be  found.*  While  the  station  nurse  may  be  particularly  solici- 
tous for  the  welfare  of  the  infant  member  of  the  family,  yet  she  must  of  necessity 
deal  with  the  whole  situation.  Parents  so  destitute  that  they  are  unable  to  buy 
milk  for  the  baby  are  not  cases  for  free  milk  alone,  but  for  general  relief. 

Provision  for  extending  relief  to  needy  cases  coming  under  the  supervision 
of  the  milk  station  was  recognized  as  an  important  factor  in  the  demonstration. 
Relief  in  the  form  of  milk,  medical  attendance,  nurse  service,  ice  for  properly 
keeping  the  milk,  hospital  accommodations,  and  outings  for  sick  mothers  and 
babies  are  needed  in  addition  to  the  general  relief;  of  these,  free  milk  for  babies  of 
poor  mothers  was  considered  most  vital  to  the  success  of  the  demonstration. 

At  first  it  was  planned  to  raise  a  large  relief  fund  to  supply  free  milk  to  all 
worthy  cases.  This  was  abandoned  because  it  was  thought  best  to  make  the 
demonstration  under  conditions  which  might  be  expected  to  exist  another  year  if 
the  work  of  conducting  a  large  number  of  milk  stations  should  be  undertaken  by 

*  Attention  is  called  to  Table  116,  showing  the  living  conditions  of  2156  families  having 
babies  enrolled  at  the  Committee's  stations. 

131 


132 


INFANT  MORTALITY  AND  MILK  STATIONS 


the  city.  As  the  city  could  hardly  be  expected  to  give  free  milk,  its  stations  would 
have  to  rely  upon  the  organized  relief  agencies  to  provide  milk  for  the  poor.  An- 
other reason  for  abandoning  the  original  plan  of  supplying  free  milk  was  the 
attitude  of  many  of  the  Committee's  larger  contributors,  who  urged  that  they 
were  also  substantial  contributors  to  established  relief  agencies  better  prepared 
not  only  to  investigate  the  needs  of  applicants,  but  to  extend  all  the  relief  necessary. 


A 

From 

* 

APPLICATION   FOR 

RELIEF 

To  5435 

■^y                                                                                                                                                       TO   BE    RETURNED    BY   RELIEF  AGENCY  TO 
fP                                                                                                                                             KEAOaUAnTEBS    OF   REFERRING   AGENCY. 

5435 

no*.                                                    iflii 

(^                                                            APPLICATION   FOR  JIELTEF 

From                                                                                                                                                      To         5435 

rja*«                                                                        1Q11 

S«'i«m« 

Addreu 

Floor 

IMo.  Rooms 

Rem 

FIRST  NAME 

AGE 

OCCUPATION 

INCOME 

HEALTH 

Man 

Woman 

Chikbsn 

Amount  of  rr|llk  now  ourehasnif  hy  family                                                                            Price 

Relief  needed 

Form  No  114  E 

(S'lJ"ff"')                                                                                   ...              Nup?^ 

Exhibit  19 

*^^"  In  April  letters  were  addressed  to  the  superintendents  of  the  various  estab- j| 
lished  relief  organizations,  in  which  the  position  of  the  Committee  and  its  con- 
tributors was  made  known.  This  brought  about  several  conferences  between 
relief-giving  organizations  and  the  agencies  conducting  milk  stations.  The  relief 
organizations  agreed  to  make  special  provision  for  the  prompt  handling  of  cases 
brought  to  their  attention  and  furnish  free  milk  to  babies  wherever  necessary.     A 


EXTENSION  OF  RELIEF  THROUGH  MILK  STATIONS  133 

uniform  system  of  reporting  cases  was  adopted  in  order  to  avoid  delay  in  extend- 
ing milk  relief  and  to  eliminate  duplication  of  effort  in  the  investigation  of  home 
conditions  of  applicants. 

Milk  relief  cases  were  divided  into  two  classes: 

L  Mothers  having  babies  registered  at  the  station  who  were  unable  to  pay 
the  difference  in  price  between  loose  milk  sold  at  the  grocery  and  the  bottled  milk 
dispensed  at  the  station ;  in  such  cases  the  organization  extending  the  relief  agreed 
to  pay  the  difference  in  price  of  the  two  grades  of  milk — these  were  termed  "partial 
relief"  cases. 

2.  Mothers  having  babies  registered  at  the  station  and  unable  to  bear  any 
part  of  the  cost  of  the  milk  required  by  the  baby — these  were  designated  "whole 
relief"  cases. 

It  was  agreed  in  both  instances  that  the  period  during  which  relief  would  be 
extended  should  depend  upon  the  emergency.  Exhibit  19  for  reporting  appli- 
cations for  milk  relief  was  adopted. 

This  record  and  reporting  form  is  divided  into  three  parts,  each  part  bearing 
the  serial  number  of  the  case.  Whenever  an  application  for  relief  was  made 
through  the  milk  station,  the  part  marked  "C"  was  filled  out  at  the  station  from 
the  information  obtained  by  the  nurse;  wherever  possible  the  information  re- 
ported on  this  form  was  verified  by  a  personal  visit  of  the  nurse  to  the  home  of  the 
applicant.     If  the  mother  applying  for  relief  had  already  registered  her  baby  at 


YOU  ARE AUTHORIZED  TO  CHARGE 

FOR QUARTS  OF  MILK  DAILY  FROM. 

FOR 


IVEW  YORK  MILK  COMMITTEE 

Date: 


Exhibit  20 


134  INFANT  MORTALITY  AND  MILK  STATIONS 

the  station,  the  information  recorded  upon  this  appHcation  was  verified  by  con- 
sulting the  case  history  card  described  in  a  previous  chapter.  After  completing 
this  record  the  nurse  forwarded  the  form  to  the  Committee's  central  office ;  here 
the  application  was  handled  by  a  special  relief  agent  formerly  connected  with  one 
of  the  organized  relief  societies.  If,  in  the  opinion  of  the  central  office,  the  case 
was  one  requiring  relief,  form  "A"  was  made  out  and  forwarded,  together  with  the 
form  "  B, "  to  the  agency  which  was  expected  to  furnish  the  relief.  Applications 
from  Hebrew  families  were  invariably  sent  to  the  United  Hebrew  Charities,  and 
all  other  applications  reported  upon  this  form  were  forwarded  to  the  Joint  Regis- 
tration Bureau,  maintained  by  the  Association  for  Improving  the  Condition  of 
the  Poor  and  the  Charity  Organization  Society,  where  it  was  determined  to  which 
society  the  case  properly  belonged.  The  action  taken  by  the  agency  was  re- 
corded on  form  "B"  and  returned  to  the  central  office  of  the  Committee,  where 
it  was  filed  with  the  copy  of  the  application,  form  "C."  The  station  nurse  was 
then  notified  as  to  extending  relief  to  the  cases  on  the  postal  card  form  shown  in 
Exhibit  20. 

Character  of  Cases  Referred 

The  character  of  cases  referred  to  organized  agencies  for  relief  were  those 
principally  of  mothers  having  ill-nourished  or  sick  babies,  due  largely  to  their 
inability  to  pay  the  price  of  a  pure,  clean  milk,  and  who,  because  of  their  poverty, 
were  endeavoring  to  rear  their  babies  on  either  condensed  milk  or  milk  purchased 
from  the  "corner  grocery,"  which,  through  an  investigation  made  by  the  Com- 
mittee, was  found  to  be  entirely  unfit  for  use  in  the  feeding  of  infants.  In  some 
instances  families  were  already  receiving  relief  in  other  forms,  but  nothing  had 
been  done  toward  supplying  the  baby  with  the  right  kind  of  food. 

Even  where  the  family  income  was  sufficient  to  supply  the  baby  with  the 
cheap  "dipped"  milk  of  uncertain  quality,  it  was  difficult  for  the  nurse  immedi- 
ately to  bring  the  mother  to  recognize  the  danger  in  giving  her  baby  this  milk; 
however,  once  an  improvement  was  shown  in  the  baby's  health,  it  was  easier  to 
persuade  the  mother  to  purchase  the  milk  from  the  station.  If  the  milk  relief 
could  be  extended  for  a  certain  period  in  such  cases,  to  the  extent  of  paying  the 
difference  between  the  price  of  loose  milk  (5  cents  a  quart)  and  the  price  of  the 
milk  dispensed  at  the  station  (7  cents  a  quart),  the  baby  would  be  brought  under 
the  influence  of  the  station,  and  upon  its  showing  improvement  the  mother  would 
consent  to  economize  in  other  ways  so  as  to  continue  giving  good  milk  to  the  baby. 
No  cases  of  this  character  were  referred  for  relief  excepting  where  extreme  ig- 
norance existed  in  the  homes,  and  the  baby,  undernourished  or  sick,  required  im- 
mediate action  by  the  nurse  in  order  to  save  its  life;  these  were  termed  "emer- 
gency relief"  cases  and  were  given  either  partial  relief  or  entire  milk  relief. 

Cases  requiring  the  attention  of  a  relief  organization,  where  the  home  condi- 
tions were  deplorable,  but  where  the  baby,  in  spite  of  a  bad  milk  supply,  was  in  no 
immediate  danger,  were  referred,  and  the  report  of  the  agency  awaited  before  any 
relief  in  the  form  of  milk  was  given.  It  might  be  stated  that  in  the  "emergency 
relief"  cases  the  nurse  was  authorized  to  extend  temporary  relief  until  the  applica- 


EXTENSION  OF  RELIEF  THROUGH  MILK  STATIONS   135 

tion  had  been  acted  upon  by  the  reUef  agency.  If,  however,  the  relief  agency  re- 
fused to  act,  the  station  was  reimbursed  by  several  individuals  particularly  in- 
terested in  emergency  cases  found  by  the  milk  station. 

Cases  which  the  relief  organizations  rejected  were  thoroughly  investigated  by 
the  special  relief  agent  of  the  Committee,  and  if  new  facts  were  brought  to  light, 
the  cases  were  again  presented  to  the  relief  agency  with  a  full  statement  of  the 
conditions.  If,  after  reopening  a  case,  no  aid  could  be  obtained  and  the  facts 
were  still  found  to  justify  the  extending  of  relief,  the  case  was  brought  to  the  at- 
tention of  persons  sufficiently  interested  to  supply  it.  Our  only  purpose  in  doing 
this  was  to  save  the  baby  even  at  the  expense  of  breaking  some  of  the  established 
rules  of  dealing  with  the  extension  of  relief  in  case  of  unworthy  parents. 

Owing  to  the  most  excellent  cooperation  existing  between  the  milk  stations 
and  the  relief  agencies,  comparatively  few  cases  considered  worthy  by  the  Com- 
mittee were  refused  aid.  The  following  is  an  example  of  a  case  refused  relief  in 
the  form  of  milk  for  the  baby,  although  considered  worthy  by  the  Committee : 

Case  No.  766. — An  Italian  family  consisting  of  father,  mother,  and  two 
children,  one  aged  twelve  years  and  the  other  four  months,  came  to  the 
notice  of  the  Mulberry  Street  milk  station  nurse;  it  was  regularly  reported 
through  the  central  office  to  the  Charity  Organization  Society.  The  father,  a 
laborer,  earned  enough  to  cover  the  rent  of  three  rooms  shared  with  another 
family;  rental,  fourteen  dollars;  mother  sews  on  pants  whenever  able ;  had  been 
ill  four  months  from  heart  trouble;  father  able  to  obtain  employment  only  two 
days  a  week,  and  under  medical  treatment  for  skin  disease.  The  mother  receives 
six  cents  a  pair  for  finishing  trousers — a  maximum  earning  of  two  dollars  per  week ; 
father's  earnings  two  and  a  half  dollars  per  week;  baby  in  poor  physical  condition, 
suffering  from  malnutrition  and  marasmus,  artificially  fed,  and  using  grocery  milk. 

An  investigator  of  the  relief  agency  reported  that  the  father  was  earning  six 
to  eight  dollars  a  week  and  the  mother  three  dollars  a  week,  and  there  seemed  no 
reason  why  the  family  should  not  manage  without  outside  help ;  but  further  inves- 
tigation by  the  Committee  confirmed  the  report  rendered  by  its  station  nurse,  and 
milk  relief  was  furnished  through  other  sources. 

On  the  other  hand,  we  have  a  station  nurse  forwarding  an  application  (Case 
No.  781)  from  a  woman  who  had  been  deserted  by  her  husband  and  who  had  her 
only  baby  registered  at  the  station.  Investigated  by  the  relief  agency,  it  was 
discovered  that  the  woman  was  already  receiving  free  milk  from  a  diet  kitchen, 
and  she  acknowledged  that  in  wanting  another  free  quart  from  the  milk  station  she 
had  misrepresented  her  circumstances. 

To  illustrate  the  effectiveness  of  close  supervision  over  relief  work  done  this 
summer  the  case  of  a  Bohemian  family  who  begged  for  milk  relief  but  two  weeks 
after  their  admittance  to  the  country  might  be  cited.  At  that  time  the  man  was 
earning  four  dollars  a  week.  The  case  was  reported  in  the  usual  way  to  a  relief 
agency,  which  brought  the  matter  to  the  attention  of  the  Commissioner  of  Immi- 
gration. Investigation  from  that  quarter  aroused  the  head  of  the  family  to 
greater  efforts.  He  soon  began  to  earn  twelve  dollars  a  week,  and  the  family  was 
made  self-supporting. 


136  INFANT  MORTALITY  AND  MILK  STATIONS 

The  care  and  good  judgment  exercised  by  the  station  nurse  in  investigating 
home  conditions  in  the  case  of  applicants  for  relief  are  shown  by  the  fact  that  out 
of  648  cases  referred  to  three  relief  agencies  during  the  period  May  1st  to  No- 
vember 1,  1911,  482,  or  74.3  per  cent.,  were  accepted  by  them  as  proper  cases  for 
relief. 

Naturally,  it  might  be  expected  that,  by  establishing  a  large  number  of  milk 
stations  throughout  the  city,  many  mothers  would  take  advantage  of  the  situation 
to  obtain  a  free  supply  of  milk  for  their  babies  during  the  summer,  even  though 
they  were  able  to  pay  for  it.  However,  such  was  not  the  case;  in  spite  of  con- 
tinued canvassing  by  nurses  who  repeatedly  urged  the  mothers  to  bring  their 
babies  to  the  station  for  supervision,  the  number  of  babies  receiving  free  milk  in 
relation  to  the  enrolment  was  even  less  during  the  demonstration  than  had  been 
the  experience  of  the  Committee's  stations  during  the  previous  year.  In  three 
stations  operated  by  the  Committee  during  the  year  1910  the  number  of  registered 
babies  receiving  free  milk  amounted  to  16.3  per  cent,  of  the  total  enrolment,  while 
during  the  period  of  the  demonstration, — May  1  to  November  1,  1911, — out  of  a 
total  registration  of  7919  different  babies,  only  724,  or  9.1  per  cent.,  received  free 
milk.  The  comparatively  small  number  receiving  milk  relief  is  due  mainly  to  the 
care  exercised  by  the  nurse  in  handling  applications  for  relief  in  a  quiet  manner, 
and  not  letting  it  become  generally  known  among  the  mothers  that  some  were 
being  aided.  The  willingness  of  relief  organizations  to  grant  relief  in  worthy 
cases  was  'not  taken  advantage  of  as  a  means  of  increasing  the  station  enrol-  .. 
ment.  " 

Table  110,  giving  by  stations  and  nationalities  the  number  of  cases  applying 
for  free  milk,  in  relation  to  enrolment,  shows  that  the  number  of  applicants  for 
free  milk  at  the  different  stations  varied  from  1.5  to  35.8  per  cent,  of  the  total 
enrolment. 

This  statement  also  shows  that  the  percentage  of  cases  applying  for  free  milk 
varied  considerably  among  the  different  nationalities.  Of  1149  American  parents 
having  babies  enrolled,  15.4  per  cent,  applied  for  relief;  of  2422  Italian  parents 
having  babies  enrolled,  12.5  per  cent,  applied;  while  the  applicants  of  1995  He- 
brew, 256  Bohemian,  666  Irish,  and  164  German  babies  enrolled  represent  9.9, 
17.7,  12.8,  and  4.2  per  cent,  respectively.  It  is  also  clear  that  the  percentage  of 
enrolment  applying  for  milk  relief  varied  considerably  among  the  different  stations 
dealing  with  babies  of  the  same  nationality.  Taking,  for  instance.  Station  No.  24, 
with  a  total  enrolment  of  310  Italian  babies,  15.1  per  cent,  applied  for  free  milk, 
while  in  Station  No.  12,  with  an  enrolment  of  358  Italian  babies,  only  6.9  applied. 
The  same  variation  is  true  as  regards  other  nationalities.  This  would  seem  to 
show  either  a  more  liberal  policy  to  be  enforced  by  the  relief  agency  working  in 
those  particular  districts,  or  a  difference  in  the  activity  of  the  station  nurse  in 
seeking  out  babies  of  families  in  destitute  circumstances  and  bringing  them  into 
the  station. 

Table  111  shows  the  monthly  increase  in  enrolment  as  compared  with  the 
new  application  for  free  milk. 


i 


The  Nurse  Has  Many  Friends  ix  Each  Tenement 


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137 


138  INFANT  MORTALITY  AND  MILK  STATIONS 

TABLE  111 


Month 


May  (enrolled  May  30,  1911) 

June 

July 

August 

September 

October 


Added  to 
Enrolment 


894 
1263 
1892 
1949 
1242 

791 


8031 


Number  of  Appli- 
cants for  Relief 


66 
124 
230 
268 
126 

89 


903 


Per  Cent. 


7.3 
9.8 
12.1 
13.7 
10.1 
11.2 


11.2 


From  the  above  it  will  be  seen  that  out  of  an  enrolment  of  894  babies  in  May, 
66,  or  7.3  per  cent.,  applied  for  free  milk,  and  out  of  1263  new  babies  added  to  the 
enrolment  during  the  month  of  June,  124,  or  9.8  per  cent.,  applied  for  free  milk. 
The  percentage  of  the  new  babies  added  to  the  enrolment  applying  for  free  milk 
reached  its  highest  point  in  August,  when  1949  babies  were  added  to  the  enrol- 
ment, and  268,  or  13.7  per  cent.,  applied  for  free  milk. 

The  following  tabulation  gives  the  number  of  instances  in  which  whole  or 
partial  relief  was  extended  and  the  authorizing  agency.  In  the  partial  relief 
cases  the  agency  paid  the  difference  between  the  price  of  the  store  milk  and  the 
price  of  the  bottled  milk  supplied  by  the  station : 


TABLE  112.— CASES  GIVEN  WHOLE  AND  PARTIAL  MILK  RELIEF 

Cases  Given 
Relief 

Whole  Relief 

Partiai 

,  Relief 

Number 

Per  Cent, 
of  Total 

Number 

Per  Cent. 

Number 

Per  Cent. 

A.  I.  C.  P 

C.  0.  S 

U.  H.  C 

335 
157 
119 

58 
6 

19 

12 

243* 

35.4 
16.5 
12.5 
6.1 
0.6 
2.0 
1.2 

25.7 

288 

153 

117 

40 

6 

1 

12 

209 

85.9 
97.4 
98.3 
68.9 

100.0 
5.2 

100.0 

86.0 

47 
4 
2 

18 

'l8 
34 

14.0 
2.5 
1.6 

Hudson  Guild 

31.0 

Union  Settlement 

N.  Y.  Foundling  Hospital 

94.7 

Other  agencies 

Individuals      (through     Mr.     Thos.     S. 
McLane) 

13.9 

949 

100.0 

826 

87.0 

123 

12.9 

The  above  statement  shows  that  out  of  949  cases  in  which  relief  was  extended, 
826,  or  87  per  cent.,  were  given  entire  relief,  and  123,  or  12.9  per  cent.,  were  given 
partial  relief.  Of  the  949  cases  furnished  milk  relief  335,  or  35.4  per  cent.,  were 
aided  by  the  Association  for  Improving  the  Condition  of  the  Poor;  157,  or  16.5 
per  cent.,  by  the  Charity  Organization  Society;  119,  or  12.5  per  cent.,  by  the 
United  Hebrew  Charities,  and  the  remainder  received  relief  through  other  sources. 
*  Includes  225  cases  given  temporary  relief  until  they  were  taken  over  by  relief  agencies. 


EXTENSION  OF  RELIEF  THROUGH  MILK  STATIONS   139 

The  following  tabulation  shows  the  number  of  cases  in  which  relief  was  ex- 
tended on  the  initiative  of  the  workers  of  the  different  relief  agencies : 

TABLE    113.— ORGANIZATIONS   EXTENDING   MILK   RELIEF   ON   THEIR  OWN 

INITIATIVE 


Relief  Agency 

Total  Number  of 

Cases  Given 

Relief 

Given  Relief  on  the  Initiative 
OF  THE  Agency 

Number 

Per  Cent. 

A.  I.  C.  P 

C.  0.  S 

U.  H.  C 

335 

157 

119 

58 

19 

6 

12 

243 

103 
26 
20 
58 
19 
6 
12 
12 

30.7 
16.5 
16.8 

Hudson  Guild 

100.0 

N.  Y.  Foundling  Hospital 

100.0 

Union  Settlement 

100.0 

Other  agencies 

100.0 

Individuals 

4.9 

Total 

949 

256 

26.9 

In  30.7  per  cent,  of  the  cases  granted  relief  by  the  Association  for  Improving 
the  Condition  of  the  Poor  the  initiative  was  taken  by  that  organization,  while 
cases  given  relief  by  the  Charity  Organization  Society  and  the  United  Hebrew 
Charities,  16.5  and  16.8  per  cent,  respectively  were  given  relief  on  the  initiative 
of  these  societies.  Of  a  total  of  949  cases  receiving  milk  relief  during  the  demon- 
stration, 256,  or  26.9  per  cent.,  were  given  relief  upon  the  initiative  of  the  relief 
agency. 

The  following  tabulation  shows,  for  the  three  main  relief  agencies,  the  number 
of  cases  referred  by  the  Committee  for  milk  relief  and  the  action  taken : 

TABLE  114.— CASES  REFERRED  FOR  MILK  RELIEF  AND  RESULT 


Society 


Number  of  cases  referred .  .  . 
Number  given  milk  relief .  .  . 

Per  cent 

Number  aided  in  other  ways 

Per  cent 

Total  number  aided 

Per  cent 

Number  refused  relief 

Per  cent 

Number  of  cases  withdrawn . 

Per  cent 


A.  I.  C.  P. 

C.  0.  s. 

U.  H.  C. 

Total 

275 

209 

164 

648 

232 

131 

99 

462 

84.4 

63.6 

60.4 

71.3 

7 

8 

5 

20 

2.5 

3.8 

3.0 

3.1 

239 

139 

104 

482 

86.9 

66.4 

63.4 

74.3 

28 

64 

54 

146 

10.1 

30.6 

33.9 

32.6 

8 

6 

6 

20 

2.9 

3.8 

3.6 

3.0 

From  the  foregoing  it  appears  that  out  of  275  cases  referred  to  the  Associa- 
tion for  Improving  the  Condition  of  the  Poor,  232,  or  84.4  per  cent.,  were  granted 
milk  relief,  and  7,  or  2.5  per  cent.,  were  aided  in  other  ways,  giving  favorable 
action  in  86.9  per  cent,  of  the  total  cases  referred;   of  209  cases  referred  to  the 


140 


INFANT  MORTALITY  AND  MILK  STATIONS 


Charity  Organization  Society,  131,  or  66.4  per  cent.,  were  given  milk  relief,  and  8, 
or  3.8  per  cent.,  were  aided  in  other  ways,  while  out  of  164  cases  referred  to  the 
United  Hebrew  Charities  99,  or  63.4  per  cent.,  were  given  milk  relief,  and  5,  or 
3  per  cent.,  were  aided  in  other  ways,  showing  that  out  of  a  total  of  648  cases 
referred  to  the  three  relief  agencies  through  the  central  office  of  the  Committee, 
favorable  action  was  obtained  in  482,  or  74.3  per  cent.,  of  the  total  cases  referred. 
Below  is  given  a  tabulation  showing  the  number  of  cases  receiving  milk  relief 
through  the  different  agencies  and  the  amount  of  money  expended  during  the 
demonstration  on  account  of  relief  given  in  the  form  of  milk  and  nursing  supplies, 
such  as  bottles,  nipples,  barley,  etc. 


TABLE 

115.— COST  OF  RELIEF 

Name  of  Society,  Etc. 

Amount  Expended 

Number  of  Cases 
Given  Relief 

Average  Amount 
Expended  per  Case 

A.  I.  C.  P 

C.  0.  S 

U.  H.  C. .  . 

Other  agencies 

Individuals 

$1645.55 

1004.99 

525.17 

372.84 

487.44 

335 

157 

119 

95 

243 

$4.91 
6.40 
4.41 
3.92 
2.01 

$4035.99 

949 

$4.25 

The  total  amount  of  relief  extended  by  the  Association  for  Improving  the 
Condition  of  the  Poor  amounted  to  $1645.55;  $1004.99  was  extended  by  the 
Charity  Organization  Society;  $525.17  by  the  United  Hebrew  Charities,  and 
$860.28  by  all  other  agencies.  The  average  amount  of  money  expended  per  case 
by  all  the  agencies  was  $4.25.  During  the  period  of  the  demonstration  the  total 
value  of  milk  and  nursing  supplies  dispensed  amounted  to  $30,860.98,  of  which, 
as  shown  by  the  foregoing  statement,  $4035.99,  or  13.0  per  cent.,  was  given  as 
relief.  This  does  not  include  a  loss  sustained  by  the  Committee  of  one-half  cent 
upon  each  quart  of  milk  dispensed  at  its  stations. 

Relief  in  other  forms  was  extended  to  needy  families  through  the  efforts  of 
the  station  nurses  independently  of  those  formally  reported  for  milk  relief.  No 
attempt  was  made  to  maintain  complete  records  where  the  station  nurse  acted  on 
her  own  initiative  in  helping  poor  mothers  to  solve  their  economic  problems,  but 
numerous  cases  came  to  the  attention  of  the  central  office  which  evidenced  the 
earnestness  and  the  good  sense  of  the  nurse.  The  efforts  to  save  some  of  the 
babies'  lives  and  to  straighten  out  home  conditions  frequently  required  a  great 
deal  of  personal  sacrifice  on  the  part  of  the  nurses;  an  example  of  a  case  by  no 
means  uncommon  was  reported  by  the  nurse  at  Station  No.  29  as  follows ;  in  this 
case  what  was  done  by  the  station  nurse  is  best  described  in  her  own  words  : 

"On  the  evening  of  May  10th,  just  as  I  was  closing  the  station  at  5  p.  m., 
a  poor,  frail  little  girl,  about  six  years  old,  came  to  the  door  of  the  station  and  said: 
'  My  mother  wants  a  bottle  of  milk.'     I  immediately  went  to  the  home,  and  there 


EXTENSION  OF  RELIEF  THROUGH  MILK  STATIONS   141 

found  five  children,  of  which  this  little  girl  was  the  eldest.  There  were  twin 
babies,  about  three  months  old,  in  the  family.  The  poverty  and  squalor  are  al- 
most indescribable.  The  mother  was  a  tall,  sickly  looking  woman,  sitting  on  the 
floor  with  the  twins  in  her  arms;  there  was  absolutely  no  food  in  the  home.  I 
returned  to  the  station,  sent  them  some  milk,  and  reported  the  case  to  the  central 
office,  requesting  that  the  relief  be  extended  for  a  time.  The  father,  I  afterward 
learned,  was  a  longshoreman  out  of  work  and  addicted  to  drink.  The  babies 
were  under-nourished  and  suffering  from  marasmus — one  of  them  was  develop- 
ing pneumonia.  Through  the  generosity  of  a  member  of  the  committee  who 
visited  the  station  a  nurse,  medicine,  and  doctor  were  obtained,  but  the  baby 
having  pneumonia  died.  I  obtained  sufficient  money  in  the  neighborhood  and 
from  my  friends  to  bury  the  little  mite.  Conditions  in  the  home  did  not  improve, 
and  the  family  was  soon  dispossessed.  The  mother  and  children  came  to  the  milk 
station,  where  they  stayed  until  night,  when  the  father  returned.  He  obtained 
a  room  on  Clarkson  Street  and  removed  the  furniture  there. 

"  I  continued  to  visit  them  in  their  new  home  and  did  everything  possible  for 
the  other  baby,  instructing  the  mother  how  to  care  for  it;  but  she,  like  her  hus- 
band, had  become  discouraged,  and  I  not  infrequently  found  her  intoxicated  and 
the  children  sitting  around  her  on  the  floor,  stupid  from  hunger.  The  baby  was 
very  frail,  weighing  only  about  four  pounds,  and  it  looked  as  if  she  too  would 
die;  but  by  visiting  the  home  every  day,  making  the  milk  formula,  and  not  trust- 
ing the  mother,  the  baby  started  a  slow  but  steady  gain  in  weight.  During  all 
this  time  the  other  three  children  came  to  the  station  twice  daily,  where  I  gave 
them  a  glass  of  milk  and  shared  with  them  the  lunches  intended  for  the  matron 
and  myself. 

"The  family  had  been  reported  to  various  relief  agencies,  but  with  unsatis- 
factory results,  as  they  claimed  the  father  refused  to  comply  with  the  require- 
ments under  which  aid  would  be  extended.  Finally,  I  brought  the  case  to  the 
attention  of  the  parish  priest,  and  through  him  the  children  were  placed  in  an 
institution. 

"Of  all  the  cases  with  which  I  have  had  to  deal  this  summer,  this  family 
required  more  thought  and  time  to  accomplish  results  than  any  other,  but  I  hold 
that  not  only  the  life  of  the  remaining  baby,  but  the  lives  of  the  three  other 
children  were  saved  through  the  efforts  of  the  milk  station." 

The  citing  of  another  case  will  show  how  the  station  nurse  helped  the  mother 
solve  a  problem  which  she  was  required  to  face.  This  mother  had  a  baby  eighteen 
months  old,  suffering  from  gastro-intestinal  trouble,  and  a  nursing  baby  ten  days 
old.  Her  husband  had  died  ten  days  before  the  baby  was  born,  leaving  the 
mother,  a  girl  of  seven,  and  two  little  babies  without  any  support.  The  case 
was  referred  to  the  Charity  Organization  Society,  which  advised  putting  the 
children  in  an  institution  and  obtaining  employment  for  the  mother;  but  the 
station  nurse  felt  that  every  endeavor  should  first  be  made  to  prevent  the  breaking 
up  of  the  home  and  the  separating  of  the  mother  from  her  children,  especially 
from  the  nursing  baby.  After  the  decision  of  the  relief  agency  the  nurse  called 
at  a  maternity  hospital,  where  applications  for  wet-nurses  are  often  received,  and 
was  given  the  address  of  a  lady  who  wanted  a  wet-nurse,  with  the  result  that  the 
mother  was  engaged  and  secured  a  good  home  in  the  country  for  herself  and  her 
nursing  baby.  The  problem  of  providing  for  the  remaining  children  was  solved 
by  the  station  nurse's  hunting  up  relatives  of  the  family  who  were  willing  to  take 
the  children  until  the  mother  could  otherwise  make  provision  for  them. 


142 


INFANT  MORTALITY  AND  MILK  STATIONS 


Case  after  case  could  be  cited,  showing  the  many  ways  in  which  the  station 
nurse  helped  distressed  mothers  with  whom  she  came  in  contact.  Too  much 
cannot  be  said  of  the  enthusiasm  and  keen  interest  manifested  by  the  nurses 
during  the  demonstration,  and  it  was  their  untiring  efforts  that  made  the  milk 
stations  real  live  social  service  organizations  for  the  districts  in  which  they  were 
located.  Mothers  soon  learned  to  appreciate  the  character  of  the  service  and  the 
spirit  manifested  by  the  station  nurses  and  their  assistants.  That  they  came  to 
the  station  for  advice  and  help  is  an  indication  of  the  possibilities  of  such  centers 
and  the  decided  influence  which  they  exert. 

The  milk  stations  cooperated  with  various  other  agencies  furnishing  help  in 
forms  other  than  milk  relief.  Those  milk  stations  located  in  the  vicinity  of  dis- 
tributing points  for  free  ice  through  the  Free  Ice  Fund  of  the  "  New  York  Herald  " 
were  provided  with  tickets  in  the  form  shown  below : 


THIS  TICKET  IS  FREE 

1 

1911 

2 

NEW  YORK  HERALD  ICE  DISPENSARIES 

This  order,  properly  certified,  on  presentation  at  one  of  the 

: 

3 

HERALD'6  Free  Ice  Stations,  entitles  the  bearer  to  ice  daily  for 

one  week. 

ICE  STATIONS  ARE  LCXJATED  AT:— 

4 

Manhattan 
Cor.  Cherry  and  Oliver  Sts.                       Cor.  Prince  and  Sullivan. Sts, 
Cor.  Monroe  and  Gonvenieur  Sts.               Cor.  Eleventi  St.  and  Avenue  B. 

5 

Cor.  Hester  and  Orchard  Sts.                        Cor.  3Tth  St.  and  Tenth  Av. 

:, 

Cor.  Lodlow  and-Rivington  Sts.                  Cor.  62d  St.  and  Amsterdam  At. 

Cor.  Stanton  apd  Attorney  Sts.                 Cor.  74th  St.  and  First  Av. 
Cor.  Lewis  and  Rivington  Sts.                    Cor.  103d  St.  and  Second  At. 

r 

3      «r     j£              1 

c        X        «j         . 
c3         oj         ©  . 

6 

Cor.  Mott  and  Broome  Sts.                         Cor.  112th  St  and  Third  At. 

5.    -5     2-      : 

Cor.  122d  St.  and  Second  Av. 
Present  this  ticket  at  6  A.  M. 

ucd  to 

(Ad 

lued  by 

te  .... 

7 

Ittaed  I  j  (Society} , 

.2                 «       Q 

Exhibit  21 


The  numbers  in  the  squares  indicate  the  days  of  the  week  the  ticket  has  been 
used  by  the  holder.  These  tickets  were  given  out  only  to  mothers  unable  to  pur- 
chase a  sufficient  amount  of  ice  to  insure  the  keeping  of  the  daily  supply  of  milk 
at  a  low  temperature.  The  name,  address,  agency  issuing  the  ticket,  and  the 
date  of  issuance  were  reported  on  the  perforated  stub.  The  stub  was  detached 
by  the  agent  dispensing  the  ice  when  the  ticket  was  first  presented  at  the  dis- 
tributing place. 

It  has  formerly  been  the  custom  of  the  "New  York  Herald"  to  distribute 
free  ice  during  the  months  of  July  and  August.  During  last  year  the  distribution 
began  early  in  June,  and  the  distributing  points  were  selected  after  a  careful  study 
of  the  locations  of  milk  stations.  An  early  morning  scene,  showing  mothers 
waiting  at  one  of  the  depots  for  ice,  is  shown  in  this  report. 


EXTENSION  OF  RELIEF  THROUGH  MILK  STATIONS   143 

In  addition  to  the  cooperation  of  the  "New  York  Herald"  in  furnishing  ice 
the  Knickerbocker  Ice  Company  issued  coupon  books  containing  31  coupons,  each 
good  for  10  pounds  of  ice  if  presented  to  any  of  their  14  ice  depots;  the  form  of  this 
coupon  is  shown  below: 


< 
u 

bu 
0) 

Z 
< 

H 

H 
O 
Z 


Book  No>  11  44 
The  Bearer, .— 


New  York,- 


.1911 


is  entitled  to  receive  Ten  Pounds  of  Ice  for  each  of  the 
attached  coupons  when  this  book  is  presented  to  the  Weigh- 
master  of  any  of  the  Ice  Depots  named  on  back  of  book,  or 
to  the  Driver  of  any  retail  ice  wagon  of  the  Knickerbocker  Ice 
Company  when  countersigned  by  an  authorized  ageht  of  the 

NEW  YORK  MILK  COMMITTHE. 


By. 


-Agent 


Ooly  one  coupon  will  be  honored  each  week  day  and  two  Saturday. 


Exhibit  22 


Book  No.44h44~       Coupon  No. !L__ 

This  Coupon  when   not  detached  is 
good  for 

TEN  POUNDS  OF  ICE 

according  to  terms  stated  on  front  cover 

of  this  book. 

HEW  YORK  MILK  COMMITTEE. 


Exhibit  23 


The  ice-box  problem  has  already  been  solved,  as  very  few  homes  visited  by 
the  station  nurse  during  the  demonstration  were  found  not  to  have  facilities  for 


144  INFANT  MORTALITY  AND  MILK  STATIONS 

keeping  the  ice.  The  education  of  mothers  as  to  the  importance  of  keeping  the 
babies'  milk  cold,  and  the  established  custom  of  the  agencies,  already  mentioned, 
of  distributing  free  ice,  has  caused  the  poor  mothers  to  solve  the  ice-box  problem 
satisfactorily.  To  the  ice-distributing  agencies  much  credit  is  due  for  their  efforts 
to  aid  the  mothers  in  keeping  the  babies'  milk  supply  sweet  and  wholesome. 

Relief  in  the  Form  of  Hospital  Care 
The  relief  extended  in  the  form  of  hospital  and  dispensary  care  of  the  sick 
babies  during  the  period  of  this  demonstration  contributed  in  no  small  way  to  its 
success.  However,  the  difficulties  in  placing  sick  babies  in  hospitals  seriously 
lessen  the  effectiveness  of  the  hospitals.  During  the  summer  a  careful  canvass  of 
the  hospitals  in  New  York  city  was  made,  and  the  result  shows  that,  for  the  care 
of  infants  under  two  years  suffering  from  general  diseases,  there  are  approxi- 
mately 800  beds  which  are  not  restricted  by  requiring  a  legal  commitment  or  a 
permit  from  the  Department  of  Charities.  These  beds  are  not  all  available  for 
the  use  of  infants  under  two  years  because  of  the  requirements  for  admission — 
none  will  receive  cases  complicated  by  mild  contagion ;  some  do  not  receive  babies 
under  one  year  of  age ;  some  require  mothers  to  accompany  babies ;  others  have 
no  accommodation  for  nursing  mothers,  while  some  receive  no  cases  during  the 
summer  and  others  receive  cases  only  during  the  summer ;  most  of  these  beds  are 
for  what  are  known  as  pay  or  part-pay  patients.  Only  21  per  cent,  are  reserved 
exclusively  for  free  patients.  Again,  these  800  beds  are  not  available  at  all 
times,  as  often  a  hospital  is  in  quarantine  with  some  contagious  disease. 

The  existing  facilities,  though  inadequate,  cannot  be  properly  utilized  under 
the  present  system,  as  no  one  knows  the  total  number  of  available  beds  at  any 
given  time,  and  to  place  a  case  one  must  telephone  from  hospital  to  hospital 
until  accommodations  are  found.  A  central  hospital  bureau  prepared  to  give 
prompt  information  as  to  available  beds  at  any  time  would  make  possible  a  better 
utilization  of  the  present  hospital  facilities,  which  are  generally  known  to  be 
woefully  inadequate. 

Because  of  the  difficulty  in  placing  sick  babies  under  proper  hospital  care 
comparatively  few  of  those  registered  at  the  Committee's  stations  were  sent  to 
hospitals.  Junior  Sea  Breeze,  which  has  special  facilities  for  the  treatment  of 
gastro-intestinal  diseases,  responded  promptly  and  satisfactorily  in  every  case 
brought  to  its  attention. 

Relief  in  the  Form  of  Outings 

Through  the  cooperation  of  various  agencies  maintaining  seaside  and  country 
homes  for  sick  mothers  and  children  the  station  nurses  were  liberally  provided 
with  tickets  to  distribute  to  those  in  need  of  this  kind  of  relief.  In  the  case  of  the 
St.  John's  Guild  Floating  Hospital,  tickets  were  good  only  for  sick  children  or 
mothers  recommended  by  either  the  family  or  station  physician. 

In  very  few  instances  did  the  station  nurses  encourage  mothers  to  take  their 
babies  to  seashore  and  country  homes  if  the  baby  was  well  and  gaining  in  weight 
under  the  station  supervision.     This  is  particularly  true  of  babies  artificially  fed, 


o 


EXTENSION  OF  RELIEF  THROUGH  MILK  STATIONS   145 

because  the  change  in  milk  and  feeding  formula  had  been  found  in  a  number  of  in- 
stances to  prove  detrimental,  at  least  for  a  time. 

However,  special  effort  was  made  by  the  station  nurses  to  obtain  for  the 
mother  a  rest  in  her  own  home  by  having  relief  agencies  provide  a  country  or  sea- 
shore outing  for  the  older  children.  This  plan  proved  far  more  beneficial  to  all 
concerned,  and  was  keenly  appreciated  by  the  overworked  mother. 


TABLE  116— SHOWING  FOR  2156  FAMILIES  HAVING   BABIES  REGISTERED  AT 
MILK  STATIONS,  RENTAL,  INCOME,  AND  LIVING  CONDITIONS 


NtJMBER   OF 

Persons 
IN  Family 

Total 
Families 

Total 

Number  of 

Persons 

Total 

Number  of 

Rooms 

Total 
Number  of 
Dark  Rooms 

Average 

Yearly  Rental 

PER  Family 

Average 

Yearly  Income 

per  Family 

2 
3 

1 
541 

2 
1623 

1 
1627 

408 

$108 
145 

$260 
641 

4 

379 

1516 

1182 

355 

145 

621 

5 

429 

2145 

1398 

372 

147 

633 

6 

304 

1824 

1019 

300 

151 

631 

7 

205 

1435 

720 

250 

156 

599 

8 

143 

1144 

499 

137 

164 

626 

9 

76 

684 

270 

92 

151 

546 

10 

45 

450 

177 

39 

183 

678 

Over  10 

33 

396 

141 

50 

196 

740 

Total 

2156 

11219 

7034 

2003 

$150 

$628 

Number  of  Families  Living  in 

1  Room 

2  Rooms 

3  Rooms 

4  Rooms 

5  Rooms 

6  Rooms 

7  Rooms 

8  Rooms 

2 
3 

1 
7 

118 

297 

104 

i3 

i 

4 

6 

70 

199 

82 

21 

1 

5 

8 

74 

195 

111 

35 

4 

2 

6 

4 

39 

131 

112 

13 

4 

1 

7 

15 

100 

67 

18 

3 

2 

8 

1 

10 

71 

45 

13 

1 

2 

9 

4 

38 

25 

6 

3 

10 

2 

12 

22 

7 

1 

1 

Over  10 

6 

20 

4 

1 

2 

Total  families 

27 
119 

332 
1479 

1049 
5250 

588 
3381 

130 

778 

19 
120 

8 
58 

3 

Total  number  of  persons 

34 

Total  number  of  rooms 

27 
10 

664 

227 

3147 
920 

2352 
640 

540 
160 

114 
19 

56 
19 

24 

Total  number  of  dark  rooms 

8 

Average  yearly  rental  per  family*  .  .  . 

182 

$124 

$138 

$171 

$211 

$258 

$229 

$384 

Average  yearly  income  per  family*  .  . 

$433 

$516 

$602 

$678 

$852 

$918 

$921 

$1716 

*  Cents  omitted  in  amounts  given. 


ID 


146  INFANT  MORTALITY  AND  MILK  STATIONS 

In  conclusion: 

L  The  milk  stations  can  be  successfully  conducted  without  making  the 
distribution  of  free  milk  a  prominent  part  of  the  work. 

2.  The  organized  relief  agencies  should  be  called  upon  to  handle  every 

case  needing  free  milk.  If  a  family  is  too  poor  to  buy  milk  for  the 
baby,  the  case  is  not  one  for  free  milk  alone,  but  for  general  relief, 
and  as  such  should  be  dealt  with  by  an  agency  prepared  to  deal  with 
the  situation. 

3.  Whatever  relief  is  extended  in  the  way  of  free  milk  should  be  given  in  a 

quiet  way.  The  desire  for  free  milk  is  contagious  with  milk-station 
mothers. 

4.  Arrangements  should  be  made  to  have  some  agency  undertake  to 

furnish  needy  cases  with  the  necessary  ice  to  keep  the  baby's  milk 
sweet  and  wholesome.  The  mothers  can  and  will  solve  the  ice- 
box problems. 

5.  Hospitals  with  many  so-called  free  or  part  free  beds  do  not  mean 

available  hospital  service  for  sick  babies.  The  standardizing  of 
requirements  for  admission  and  the  establishment  of  a  Central 
Hospital  Bureau  for  information  will  insure  a  better  utilization  of 
exisiting  hospital  facilities. 

6.  The  older  children  may  be  sent  away  for  a  country  or  seashore  out- 

ing, but  the  baby  should  be  left  at  home  with  its  mother.  Travel 
and  change  of  milk  and  feeding  formula  may  be  disastrous  to  the 
bottle-fed  baby. 

7.  The  milk  station  should  be  made  a  place  where  mothers  will  come  with 

their  troubles.  The  nurse  should  be  prepared  to  know  what  to 
advise;  if  she  shows  good  judgment,  she  will  win  the  confidence  and 
friendship  of  the  mother. 


CHAPTER  IX 

Establishment  and  Operation  of  Milk  and  Health  Stations 

Survey  to  Determine  the  Needs  of  Each  Locality 

A  preliminary  survey  was  made  in  1910  to  determine  how  many  milk  stations 
would  be  necessary  to  carry  on  an  intensive  demonstration  in  Manhattan.  In- 
formation and  experience  obtained  in  operating  six  milk  stations  during  1909  and 
census  figures  served  as  the  basis  for  this  study.  The  records  of  these  milk  sta- 
tions were  analyzed,  a  map  of  the  district  in  which  the  stations  were  located  was 
made,  and  in  each  block  was  indicated  the  number  of  babies  registered  at  the 
station.  The  number  of  babies  was  then  considered  in  relation  to  area  and 
density  of  baby  population. 

As  the  six  stations  were  located  in  different  sections  of  Manhattan  it  was 
thought  that  their  experience  could  be  taken  as  an  index  of  what  might  be  ex- 
pected if  additional  stations  were  opened  in  similar  districts.  Accordingly,  it 
was  estimated  that  the  average  sphere  of  influence  in  acres  of  a  station  on  the 
lower  East  Side  was  16;   on  the  upper  East  Side,  24,  and  on  the  West  Side,  22. 

By  considering  station  enrolment  in  relation  to  baby  population  it  was  esti- 
mated that  in  districts  with  more  than  25  children  per  acre  25  per  cent,  might  be 
expected  to  come  under  the  supervision  of  milk  stations;  in  districts  with  15  to 
25  children  per  acre,  10  per  cent.;  and  in  districts  with  less  than  15  children  per 
acre,  5  per  cent. — might  be  expected  to  come  under  the  supervision  of  stations. 
Allowing  100  babies  as  a  maximum  enrolment  for  a  milk  station,  it  was  estimated 
that,  to  provide  for  the  entire  number  of  babies  needing  milk-station  supervision 
in  Manhattan,  60  stations  in  addition  to  those  already  in  operation  would  be 
required. 

In  April,  1911,  after  the  Committee  had  secured  sufficient  funds  to  begin  a 
demonstration,  another  survey  was  made  to  determine  the  number  of  babies 
under  two  years  who  might  be  brought  under  the  influence  of  the  milk  stations. 
This  study  was  made  by  wards  or  parts  of  wards,  in  which  the  block  population 
was  used  as  the  basis  for  estimating  the  number  of  children  under  two  years  of 
age.  From  this,  together  with  the  experience  of  the  stations  already  in  opera- 
tion, it  was  estimated  that  a  minimum  of  13,137  babies  under  two  years  could  be 
brought  under  the  influence  of  milk  stations  if  these  were  properly  located.  In- 
formation from  organizations  already  conducting  milk  stations  showed  that 
4500  of  the  total  estimated  number  were  already  under  the  supervision  of  estab- 
lished stations,  leaving  8637  babies  to  be  provided  for.  After  a  thorough  canvass 
of  the  districts  not  covered  by  milk  stations  it  was  decided  that  if  28  stations  were 
established  by  this  Committee  in  addition  to  the  5  to  be  maintained  in  Man- 
hattan by  the  Department  of  Health  and  22  by  other  agencies,  it  would  be  pos- 

147 


148  INFANT  MORTALITY  AND  MILK  STATIONS 

sible,  by  employing  extra  nurses,  to  care  for  the  remaining  8637  babies  needing 
supervision. 

With  the  tentative  locations  for  new  stations  indicated  on  a  map  of  Man- 
hattan, a  careful  inspection  of  each  district  was  made.  The  clergy  of  all  denomi- 
nations, as  well  as  social  workers  and  representatives  of  hospitals  and  dispensaries 
in  the  locality,  were  interviewed,  and  many  valuable  suggestions  were  obtained 
relative  to  the  proposed  location  of  the  station  in  their  district. 

Once  having  determined  the  vicinity  in  which  the  station  was  to  be  opened, 
a  canvass  was  begun  for  suitable  quarters;  in  selecting  these,  an  endeavor  was 
made  to  have  the  stations  placed  on  streets  which  were  most  used  by  the  mothers 
of  the  neighborhood. 

Kind  of  Quarters  Selected 

In  all  but  five  instances  stores  were  selected  for  quarters  for  the  milk  sta- 
tion, and  an  effort  was  made  in  each  case  to  obtain  at  least  600  square  feet  of 
floor  space,  although  in  certain  districts  this  was  not  possible,  as  nearly  all  the 
stores  were  the  so-called  single  stores,  having  a  width  of  10  feet  and  extending 
back  40  to  45  feet.  Wherever  possible  stores  were  obtained  having  partitions 
so  arranged  as  to  give  one  large  room  in  front  with  two  smaller  rooms  in  the  rear. 
(See  Exhibit  24.) 

Free  quarters  were  provided  for  five  of  the  stations  by  different  organiza- 
tions— two  of  these  were  in  settlement  houses ;  one  in  an  industrial  school ;  one 
in  a  dispensary,  and  one  in  the  room  adjoining  the  vestibule  of  a  chapel.  It 
became  necessary,  however,  to  remove  the  station  from  the  chapel  after  occupying 
the  quarters  for  six  weeks,  owing  to  the  refusal  of  mothers  to  bring  their  babies 
to  a  station  located  in  a  church  not  of  their  religion.  No  difficulty  was  encoun- 
tered in  obtaining  a  large  enrolment  at  stations  located  in  settlements;  in  fact, 
with  one  exception,  the  settlement  stations  had  the  largest  enrolment  throughout 
the  summer  of  any  of  the  Committee's  stations. 

Equipment  and  Cost 
A  careful  list  of  the  equipment  necessary  for  the  station  was  compiled,  taking 
into  consideration  the  economy  of  floor  space  and  the  amount  of  money  available. 
The  following  is  a  complete  list  of  the  furniture  and  equipment  purchased  for 
each  station,  as  well  as  the  cost  of  same: 

LIST  OF  EQUIPMENT  OF  STATIONS 

Folding  chairs  (24)  wooden $15.50 

Stool  (1),  white  enamel,  wooden 87 

Cabinet  (1),  white  enamel,  wooden 16.25 

Mirror  (1),  white,  size  123^  x  16  inches 60 

Blackboard  (1),  size  24  x  36  inches 32 

Chairs  (2),  white  enamel 3.90 

Table  (1),  size  24  x  30  inches,  white  enamel,  wooden 3.75 

Table  (1),  size  20x48  inches,  white  enamel,  wooden,  with  drawer  213^^ 

X  19  inches 6.50 

Table  (1),  size  24  x  60  inches,  white  enamel,  wooden,  5  drawers — 4  side, 

1  long 7.75 

Desk  (1),  size  24  x  40  inches,  white  enamel,  wooden,  5  drawers — 4  side, 

1  long 10.25 


ESTABLISHMENT  AND  OPERATION  149 

Wash-stand  (1)  . $  3.50 

Refrigerator  (1),  size  27  inches  x  5  feet,  oak 34.00 

Linoleum  (to  measure),  65  cents  per  yd.,  made  and  laid 

Pan  for  refrigerator 55 

Folding  screen,  enamel,  wooden,  muslin  filling,  size  5  ft.  83^  inches  x  193^ 

inches 5.00 

Howe  scales  with  special  pan  (1) 9.00 

Pad  for  scales 22 

Double  boiler  (1),  1  quart,  enamel 57 

Strainer  (1),  large,  to  fit  quart  measure,  enamel 25 

Quart  measure  (1),  enamel 30 

Spoon  (1),  enamel,  white,  size  14  inches 10 

Jars  (4),  glass,  1  quart,  with  tops 88 

Funnel  (1),  glass 09 

Bath-tub  (1),  baby's 1.05 

Graduate  glass  (1),  16  ounce 20 

Kettle  (1),  1  quart,  enamel 80 

Tea-kettle  (1),  4  quarts,  enamel 78 

Pitcher  (1),  gallon,  enamel 65 

Saucepan  (1),  gallon,  white  enamel 80 

Dishpan  (1),  size  16  x  5  inches,  enamel 60 

Mop  (1)  and  handle 30 

Boiler  (1),  No.  6  Kramer 1.12 

Irons  (2),  6  pounds,  each 44 

Ironing-board  with  cover,  size  43^  feet 80 

Scrub-pail  (1)  and  wringer  (1) 1.00 

Washboard  (1) 32 

Bottle-cleaners  (2)  for  small  nursing  bottles 50 

Bottle-cleaner  (1),  large,  with  wooden  handle 25 

Nail-brush  (1) 04 

Scrub-brush  (1) 11 

Soap-dish  (1),  enamel 15 

Towel-rack  (1),  nickel 42 

Clothes-line  (1) 45 

Broom  (1) 30 

Ice-pick  (1)  and  hammer  (1) 25 

Dust-pan  (1)  and  brush  (1) 31 

Slop-pail  (1),  enamel 63 

Hand-basin  (1),  enamel 24 

Bowl  and  pitcher  for  wash-stand,  enamel 97 

Window-screening 25 

White  dotted  muslin  (20  yards) 1.90 

Towels  (12),  hand,  1  yard  each,  hemmed 1.38 

Towels  (12),  dish,  1  yard  each,  hemmed 1.32 

Floor-cloths  (6),  3^  yard  each,  hemmed 66 

Scrap-basket  (1),  wire 35 

Clock  (1),  New  Haven  alarm 60 

Inkstand  (1),  with  2  bottles  and  pen-holder 75 

Cash-box  (1),  tin,  size  7x9x2  inches,  6  compartments 55 

Thermometer  for  refrigerator 48 

Dairy  thermometer 17 

Tongue  depressors 60 

Clinical  thermometer  (two-minute) 50 

Breast-pump  (1) 30 

Pyoscope  (1) 45 

Letter-index,  files  (2)  for  charts,  at  $1.40 2.80 

Card-drawer  files  (daily  record  cards),  at  80  cents 1.80 

The  average  cost  of  equipment  was  $184.72  per  station.  All  the  furniture 
was  white  enamel,  with  the  exception  of  the  folding  chairs,  and  was  made  to  order 
for  the  Committee.  With  the  exception  of  the  refrigerators,  the  equipment 
selected  proved  well  adapted  to  the  needs  of  the  milk  station.  The  refrigerators, 
although  of  well-known  make,  did  not  prove  satisfactory,  as  it  was  impossible 
to  keep  the  temperature  of  the  milk  below  55°  F.  unless  the  bottles  were  placed 


150  INFANT  MORTALITY  AND  MILK  STATIONS 

in  direct  contact  with  the  ice.  It  is  doubtful  if  any  refrigerator  will  give  as  satis- 
factory results  in  keeping  milk  at  a  low  temperature  as  an  ice-chest  in  which  the 
bottles  can  be  buried  in  cracked  ice. 

Arrangement  of  Interior  of  Station 

Wherever  possible,  as  has  been  said,  stores  with  three  rooms  were  obtained  for 
milk  stations — the  front  room,  being  the  largest,  was  used  for  a  class-room  and  for 
the  dispensing  of  milk.  In  the  exhibit  showing  floor  plan  of  a  three-room  station 
the  milk-dispensing  table  is  in  the  fore  part  of  the  front  room.  In  some  places  a  rail 
and  gate,  togetlier  with  the  table,  separated  the  remaining  part  of  the  room  used 
for  class  purposes  from  the  milk-dispensing  portion.  A  three-paneled  screen  is 
utilized  to  separate  the  class-room  from  the  view  of  the  street.  The  refrigerator, 
with  a  capacity  of  200  quart  bottles  of  milk,  is  placed  alongside  of  the  cabinets. 
These  cabinets  contained  nursing  bottles  of  various  sizes,  barley,  milk-sugar, 
nipples,  borax,  and  other  supplies  which  were  sold  to  the  mothers  at  cost.  A 
portion  of  the  front  room  utilized  for  class  work  or  as  a  waiting-room  for  mothers 
on  consultation  day  with  the  physician  is  provided  with  24  to  36  folding  camp- 
chairs  and  a  table  for  the  use  of  the  nurse  or  physician  conducting  class  work. 

The  adjoining  room  is  known  as  the  "demonstrating  room" — this  is  the 
smallest  of  the  three;  here  mothers  were  instructed  in  the  modification  of  milk, 
bathing  and  dressing  of  babies,  etc.  It  is  provided  with  a  large  demonstrating 
table,  a  sink  with  running  water,  wall  shelves  on  which  were  kept  the  utensils 
used  in  demonstrating  the  modification  of  milk,  a  cabinet  for  supplies,  and  a 
cloak  closet. 

The  third  or  rear  room  is  nearly  twice  as  large  as  the  demonstrating  room,  and 
is  known  as  the  "consultation  room,"  in  that  it  is  used  almost  exclusively  for  in- 
dividual consultation  work  with  mothers.  The  station  physician  and  nurse  are 
each  provided  with  a  desk.  At  the  side  of  the  room  nearest  the  nurse's  desk  is  a 
table  holding  the  scales  used  in  weighing  babies,  and  on  the  opposite  side  is  the 
cabinet  containing  medical  supplies  used  in  the  station  work. 

The  arrangement,  as  per  the  plan  outlined,  makes  it  possible  for  a  station 
with  apparently  small  quarters  to  handle  quite  conveniently  a  great  many  cases. 
The  use  of  that  part  of  the  front  room  nearest  the  street  door  for  receiving  mothers 
or  older  children  coming  for  milk,  without  interfering  with  the  work  carried  on 
in  the  other  part  of  the  station,  is  particularly  advantageous.  The  class-room 
makes  it  possible  for  the  general  lessons  in  hygiene  and  care  of  the  baby  by  the 
station  nurse  and  the  special  talks  by  the  station  physician  to  be  given  without 
interruption  from  persons  coming  in  for  the  sole  purpose  of  obtaining  the  day's 
supply  of  milk.  By  having  the  consultation  room  in  the  rear,  a  good  light  is 
assured  for  the  examination  of  babies  by  the  physician.  The  room  affords  a 
certain  amount  of  privacy,  and  the  mother  feels  that  the  station  is  giving  her 
baby  individual  attention  and  that  she  is  being  granted  a  personal  consultation, 
rather  than  being  instructed  as  one  of  a  group.  The  character  and  amount  of 
individual  attention  given  to  each  baby  and  mother  by  the  station  physician  and 
nurse  determine  largely  the  influence  which  the  station  is  to  have  upon  that 
mother. 


DOCTDR^ 
DESK 


a 


nURSE  s 
DESK 


CONSULTATION 

Roon 


□an 


aaoana 

DOCDCa 

" □□□□□ . 

ucacnn' 
□□noD 

□□□DO 


D 


M»< 


DISPENSER'S 
TABLE 


a 
a 


CLASS 
MILKDISPEHSING 


Exhibit  24 

Floor  Plan  of  Milk  Station 

Stores  Are  Used  For  Milk  Stations 


ESTABLISHMENT  AND  OPERATION  151 

All  records  with  the  exception  of  the  ledger  for  recording  the  milk  dispensed 
are  kept  in  the  consultation  room.  On  the  walls  of  the  front  room  of  the  station 
are  placards  giving  advice  or  warnings  to  mothers.  A  blackboard  in  the  milk- 
dispensing  portion  of  the  station  affords  a  means  of  notifying  mothers  of  changes 
in  clinic  hours  and  other  important  notices,  such  as  announcements  or  reminders 
of  clinics  and  classes  to  be  held,  excursions  to  parks  or  seashore,  "little  mothers'  " 
meetings,  etc. 

Painting  and  Decorating  the  Station 

A  blue-and-white  color  scheme  for  both  th,e  city  milk  stations  and  the  Com- 
mittee milk  stations  was  adopted.     The  exterior  of  the  station  was  a  light  blue 


LOOK  FOR 

THE  BLUE  FRONTS 

BABIES'  PURE  MILK  STATIONS 

Every  Summer  thousands  of  Babies  die 

We  can  save  your  Baby 

Ask  us  how 

Coinniittee  tor  Reductioii  of  Infant  Mortality 

New  York  Milk  Committee 


Exhibit  25 

Placards  Used  to  Advertise  the  Stations 

(Printed  in  Five  Languages;  Size,  22  x  28  inches) 

with  white  trimmings  around  the  windows.  White  calcimine  was  used  for  the 
ceiling,  and  a  white-enamel  paint  for  the  side  walls — in  some  cases  white-enamel 
paint  for  the  side  walls  was  used  up  to  a  height  of  5  feet,  and  the  remaining  por- 
tion of  the  wall  calcimined.  In  some  of  the  city  stations  blue  was  used  in  mark- 
ing borders  in  the  interior.  Having  the  exterior  of  the  station  a  striking  blue, 
this  being  an  unusual  color  for  fronts  of  buildings,  served  at  once  to  attract  the 
attention  of  the  neighborhood,  and  it  was  soon  known  as  the  "House  with  the 


152  INFANT  MORTALITY  AND  MILK  STATIONS 

Blue  Front,"  and  greatly  aided  the  nurses  in  directing  the  mothers  to  the  milk 
station,  by  simply  giving  the  street  upon  which  it  was  located  and  telling  them  to 
look  for  the  "House  with  the  Blue  Front."  In  most  of  the  stations  there 
were  signs,  either  at  right  angles  to  the  front  of  the  station  or  painted  upon  the 
large  plate-glass  window.  The  interior  of  the  station  being  in  white,  its  white- 
enamel  furnishings  and  linoleum  floor-covering  gave  the  visitor  the  impression 
of  clean,  sanitary  surroundings. 

Building  up  the  Station  Enrolment 
The  location  of  the  station  was  determined,  quarters  secured,  and  the  prem- 
ises renovated  and  painted,  furniture  and  equipment  installed,  and  the  organiza- 
tion was  completed  by  engaging  a  nurse,  matron,  and  a  physician  for  carrying 
on  the  work  of  the  station. 

With  this  personnel,  work  was  begun  immediately  to  build  up  a  station 
enrolment.  The  nurse  visited  the  dispensaries,  hospitals,  settlements,  clergy, 
social  workers,  private  practitioners,  and  druggists  of  the  district  to  make  known 
to  them  the  aims  and  purpose  of  the  station,  and  to  obtain  their  cooperation, 
urging  them  to  refer  babies  to  the  station  for  feeding  supervision.  The  following 
postal-card  form  was  distributed  to  facilitate  referring  cases : 


Date 

We  have  this  day  temporarily  referred  for  feeding  to  Milk  Station 

No Street 

of  the  NEW  YORK  MILK  COMMITTEE 

Name 

Address _ 

Remark: 


Physician 


Exhibit  26 

Wall-cards  and  convenient  pocket-cards,  giving  the  locations  of  all  the  milk 
stations  of  the  city  and  the  organization  conducting  the  work,  were  left  with 
those  who  were  willing  to  cooperate.  Large  printed  signs  were  placed  in  the 
window  of  the  station,  to  announce  the  work  that  was  to  be  carried  on,  and  to 
notify  mothers  to  bring  their  babies  for  examination  by  the  station  physician. 
These  were  also  placed  in  store  windows,  and  not  infrequently  were  to  be  seen  in 
corner  saloons.  Hand  leaflets,  showing  contrasts  between  sick  and  well  babies, 
and  urging  mothers  to  bring  their  babies  to  the  stations,  were  distributed  by 
druggists  and  shopkeepers,  with  good  results. 


ESTABLISHMENT  AND  OPERATION 


153 


After  making  this  announcement  of  the  opening  of  the  stations,  the  nurse 
began  canvassing  systematically  the  tenements  on  each  street  of  her  district. 
From  the  janitors  she  obtained  information  as  to  the  families  having  babies  under 
two  years  of  age,  and  these  homes  were  visited  and  the  mothers  urged  to  come  to 
the  stations  with  their  babies.  They  were  told  the  purpose  of  the  station  and 
the  kind  and  price  of  the  milk  dispensed.  As  the  babies  became  registered  the 
mothers  were  given  circulars  to  distribute  among  their  neighbors  and  friends ; 
they  were  asked  to  bring  with  them  other  mothers  whose  babies  were  sickly,  to 
get  them  well;  and  those  whose  babies  were  well,  to  learn  how  to  keep  them  well. 

Each  home  having  a  baby  under  two  years  of  age  needing  supervision  was 
visited,  and  the  following  card  form  was  filled  out: 


Name   Jf' 


ELIGIBLE   BAB^'        FUght  O^  frt.  h^-^\it.  rr.  house 


Address 


'Ty  l^-%'<^%/l/^^  tpy . 


Breast  Fed 


Partly  Breast  Fed. 


Artificially  Fed  f^.. 


j^jjLfT- Raw...  Pasteurized  /Modified. 

Bottled  ...  Loose ^<^ondensed. 


Date 


fkf.. 


Condition 


'>^ 


Supplied  by 


Pat. 
Food 


Action  Taken — Remarks 


"llr^ij  ^t3!Zi^  ^^^^^_/;^^^^fci2 


"L^y 


XAELE 

Food 


N.Visit 


Mf 


i  2 

I  »5 
0 


V 
M 


^ 


Id  lU^HtP^U^^-  U'li/^^^^  ^^^^xJ^ 


^ 


% 


H 


Jt^  j^  ^aA4^^^^    ^-^^^^^t^ZJ 


^ 


OJoi^-^iu  i^'^-  ^i^^*i^^  gj/ 


^ 


H 


^iicj  liroT^^  ^^^^^  /"<^i^;L^ 


Exhibit  27 


This  is  a  salmon-colored  card,  3x5  inches,  punched  so  as  to  carry  in  a  loose- 
leaf  cover,  and  is  known  as  the  "Eligible  Baby"  record.  The  term  "eligible 
babies"  refers  to  those  babies  who  live  within  the  district  which  the  station  is 
supposed  to  serve,  and  who,  in  the  judgment  of  the  nurse  on  visiting  the  homes, 
need  the  care  and  supervision  of  the  milk  station.  In  other  words,  every  home 
visited  in  which  conditions  were  unfavorable,  due  either  to  poverty,  ignorance,  or 
neglect,  the  baby  was  considered  a  candidate  for  registration  at  the  milk  station. 

The  above  record  shows  that  this  particular  baby  lives  on  Cornelia  Street, 
second  flight,  back  hall,  and  apartment  to  the  right.  The  baby  was  born  on 
April  1,  1911,  and  artificially  fed  on  "loose"  (dipped)  milk  purchased  at  a  gro- 
cery store.  The  date  of  the  first  visit  to  the  home  was  August  15th;  the  con- 
dition of  the  baby  indicated  was  "poor."  The  nurse  urged  the  mother  to  attend 
the  clinic,  and  instructed  her  in  the  care  of  bottles,  nipples,  and  milk.  The  nurse 
revisited  the  home  on  August  19th,  23d,  27th,  and  31st;  the  last  was  for  the  pur- 


154 


INFANT  MORTALITY  AND  MILK  STATIONS 


pose  of  bringing  the  mother  to  the  station  to  have  the  baby  examined  by  the 
station  physician. 

A  Registered  Baby 

Once  a  mother  brings  a  baby  to  the  station  and  the  baby  is  examined  by  the 
station  physician,  and  the  mother  promises  to  follow  the  instructions  given  to  her 
by  the  physician  and  nurse  and  attend  the  consultations  as  directed,  the  baby 
becomes  a  "Registered  Baby,"  and  the  following  card  record  is  made: 


t 

i  ^ 
I  t^ 

0 

z 


B0RN.,4~.l.::'.i  f      REGISTERED    BABY  Flight   2j     frt.  bck.  rt^  [ft.  rr.  house 

Relief  Case  ...k ^asr I.4r..l 


Name 


L 


Attendance  at  Medical  Consultation 


Case. 
Address       2>5  Govncl  \0i    St 


Date 


^/i 


31 


Condition 


Hi 


Action 


B.W.die.t  J(ohr3 


Home  Visits 


Date 


8 


V51 


Action  Taken 


Instructed  mothc.r 


Next 
Visit 


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how  to  m(it{e  R  W 


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n^ 


Attendance  at  Medical  Consultation  | 

Home  Visits 

Next 
Visit 

Date  Condition 

Action 

Date 

Action  Taken 

7l8 

Imbrovec 

So  me.  disConTin. 

e.d 

Saline,  ivvigntion 

%4 

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gcod 

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modij'iCQtion 

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Exhibit  28 


GENERAL    HEALTH 

CONDITION 

INDICATED   BY   PERCENTAGE 

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p  ESTABLISHMENT  AND  OPERATION  155 

I  This  card  contains  the  important  information  shown  on  the  "Eligible"  card 
of  the  baby,  and  the  current  information  as  to  the  clinic  consultation,  the  action 
taken  by  the  station  physician,  the  home  visits,  and  notes  of  the  station  nurse. 
It  forms  the  working  memorandum  which  can  be  conveniently  used  by  the  nurse 
in  exercising  supervision  and  control  over  the  case.  This  card  form  also  has 
punched  holes  for  carrying  in  the  loose-leaf  binder  whenever  the  nurse  makes  her 
home  visits  upon  the  case. 

Both  the  "Eligible  Baby"  and  the  "Registered  Baby"  card  forms  are  filed 
at  the  station  in  a  tickler  file,  under  the  date  on  which  the  case  is  to  receive  further 
attention.  When  the  "Eligible  Baby  "  becomes  a  " Registered  Baby,"  the  " Elig- 
ible" card  record  is  then  filed  alphabetically,  in  a  terminated  record  file,  and  the 
"Registered"  baby  card  beomes  the  active  record.  When  the  registered  baby 
is  attending  clinic  regularly,  with  no  unusual  conditions  prevailing  which  would 
require  home  visiting  and  special  work  on  the  part  of  the  nurse,  this  record  is 
filed  by  street  and  numerically  by  the  house  number.  If  home  visiting,  etc., 
is  necessary,  the  card  is  filed  in  a  tickler  file  according  to  the  date  on  which  further 
action  regarding  the  case  is  to  be  taken.  Upon  termination  of  a  case  by  removal, 
transfer  to  hospital,  or  other  agency,  etc.,  the  record  is  then  filed  alphabetically 
in  a  file  for  terminated  cases.  The  registration  card  gives  information  as  to  the 
name  of  the  baby,  the  address,  date  of  birth,  whether  the  case  is  one  in  which 
relief  is  extended,  and  the  case  number.  The  form  also  provides  for  recording  the 
attendance  of  the  baby  at  the  medical  consultations,  its  conditions,  and  the  action 
taken  as  a  result  of  the  medical  examination.  It  further  provides  for  recording 
the  home  visits  made  by  the  nurse  by  giving  the  date  of  the  visit,  the  action  taken, 
and  the  date  of  the  next  visit,  if  such  is  necessary.  The  date  indicated  for  the 
next  visit  determines  the  date  under  which  the  card  is  to  be  filed  in  the  tickler 
file  by  the  nurse  upon  her  return  to  the  station. 

Individual  Weight  Chart  and  Medical  Record  of  Baby 
In  addition  to  the  foregoing  card  record  maintained  for  each  registered  baby, 
a  weight  chart  and  medical  record  is  kept  in  each  case.  This  record  is  a  9^  x  1234 
inch  card,  printed  on  both  sides.  One  side  is  used  for  recording  information 
relating  to  the  baby  if  under  one  year  of  age ;  the  other  side,  if  over  one  year  of  age. 
This  record  is  made  up  at  the  time  the  baby  is  first  examined  by  the  station 
physician,  and  the  mother  agreed  to  follow  the  instructions  of  the  physician  and 
nurse.     (See  Exhibit  29.) 

This  record  provides  for  recording  the  name  and  address  of  the  case,  the 
date  of  birth,  the  number  of  the  case,  the  station  at  which  the  baby  is  registered, 
sex,  whether  full-term  or  premature  birth,  reported  weight  at  birth,  length  of 
time  breast-fed,  length  of  time  mixed  fed,  the  reason  for  artificial  feeding,  the 
kind  of  food  given,  nationality  of  mother,  and  the  names  of  the  station  physician 
and  nurse.  All  this  information  relates  to  conditions  existing  at  the  time  the 
baby  is  registered. 

The  major  part  of  the  form  provides  for  recording  information  relating  to  the 
case,  as  noted  by  the  station  physician,  and  the  kind  of  action  taken.     In  the 


156 


INFANT  MORTALITY  AND  MILK  STATIONS 


upper  part  of  this  space  provision  is  made  for  recording  the  month  and  the  date 
the  case  comes  under  the  observation  of  the  station  physician,  the  kind  of  formula 
for  home  modification  if  artificially  fed,  instructions  regarding  the  number  and 
intervals  of  feeding  if  breast-fed,  and  the  weight  of  the  baby  in  pounds  and  ounces 
for  the  age  in  weeks. 

The  lower  part  of  the  chart  records  the  general  condition  upon  medical 
examination  at  entry,  the  physician's  notes  regarding  the  case,  the  average  weight 
curve  for  normal  babies,  and  the  weight  curve  of  the  particular  baby  under  ob- 
servation. The  reverse  side  of  the  card  records  similar  information  for  the  baby 
in  its  second  year,  the  main  difference  being  in  the  normal  weight  curve.  These 
chart  records  are  filed  alphabetically,  according  to  the  clinic  or  the  consultation 
day  on  which  the  mother  is  instructed  to  bring  her  baby  to  the  station. 

Whenever  a  case  is  transferred  to  another  station,  the  chart  record,  together 
with  the  other  records  pertaining  to  the  case,  is  forwarded  to  the  station  to  which 
the  baby  is  being  transferred.  If  the  case  is  terminated  for  whatever  cause, 
the  chart  is  filed  alphabetically  under  terminated  cases,  and  the  reason  for 
termination  is  reported  to  the  central  office. 

Case  History  Card 
In  addition  to  the  registration  card  and  weight  chart  and  medical  record,  a 
case  history  card  is  made  out  for  each  baby  registered.  This  gives  information 
concerning  conditions  which  prevailed  previous  to  admittance  to  the  station, 
and  takes  the  character  of  a  social  record  of  the  case.  This  is  a  5  x  8  inch  card, 
printed  on  one  side ;  the  following  shows  the  form  of  this  record : 


Exhibit  30 


ESTABLISHMENT  AND  OPERATION  157 

The  information  relates  largely  to  a  history  of  the  baby  and  its  home  condi- 
tions. The  record  is  compiled  as  soon  as  possible  after  the  baby  becomes  regis- 
tered, generally  on  the  first  visit  of  the  nurse  to  the  house  after  registration.  The 
arrangement  of  items  provides  a  convenient  way  for  recording  data  by  checking 
the  items  upon  which  information  is  desired.  The  purpose  of  this  history  card 
was  to  ascertain  the  character  of  the  homes  which  the  milk  station  was  able  to 
reach,  and  the  previous  history  of  cases  coming  under  their  influence.  It  greatly 
facilitated  matters  in  looking  up  a  case  whenever  application  for  relief  was  made. 

Artificially  Fed  Babies 

When  artificial  feeding  is  prescribed  for  a  registered  baby,  the  mother  re- 
ceives the  daily  supply  of  milk  from  the  station.  If  it  is  not  a  case  of  extreme 
poverty,  she  is  required  to  pay  seven  cents  for  a  quart  bottle  and  four  cents  for  a 
pint  bottle  of  milk.  If  the  case  deserves  relief,  milk  is  furnished  upon  instruction 
from  the  central  office  after  the  case  has  been  investigated  and  some  organization 
or  individual  has  agreed  to  reimburse  the  station  for  the  amount  of  the  value  of 
the  milk  dispensed  in  the  form  of  relief. 

For  the  purpose  of  control  over  mothers  coming  to  the  station  for  their  milk 
supply  a  ledger,  providing  a  page  for  recording  information  relating  to  each  case, 
is  maintained ;  the  case  is  identified  by  the  case  number  given  the  registered  baby. 
The  quantity  of  milk  dispensed  each  day,  also  the  feeding  formula,  as  prescribed 
by  the  station  physician,  is  here  recorded.  All  this  affords  an  important  means 
of  control  over  mothers  having  babies  registered  at  the  station  and  artificially 
fed,  as  the  matron  dispensing  the  milk  promptly  reports  to  the  nurse  cases  where 
the  mother  fails  to  come  for  her  daily  supply.  These  are  immediately  followed 
up  by  the  station  nurse,  to  determine  the  cause;  usually,  if  the  baby  is  well, 
mothers  are  apt  to  be  negligent  or  careless  in  making  their  station  purchase, 
and,  through  motives  of  economy,  substitute  cheap  grocery  milk. 

The  ledger  has  column-rulings  with  the  following  headings : 

Date 

Milk  Dispensed 

Quarts 

Pints 
Cash  Received 
Relief  charged  to 
Formula  prescribed  (oz.) 

Whole  Milk 

Oatmeal  Water 

Lime  Water 

Barley  Water 

Boiled  Water 

Plain  Water 

Milk  Sugar 

Cane  Sugar 

Feeding  Intervals 

By  having  recorded  the  feeding  formula  of  the  baby  receiving  the  milk,  the 
nurse  and  the  matron  have  conveniently  at  hand  information  as  to  the  feeding  and 
the  quantity  of  milk  the  mother  should  buy  for  her  baby.     It  is  further  used  for 


158  INFANT  MORTALITY  AND  MILK  STATIONS 

questioning  the  mother  in  regard  to  the  feeding  formula  prescribed.  If  no  change 
has  been  made  in  this  for  several  weeks,  it  is  an  additional  means  of  bringing  to 
the  nurse's  attention  the  failure  of  the  mother  to  bring  the  baby  to  the  consulta- 
tions for  the  purpose  of  having  any  necessary  changes  made  in  the  feeding  formula, 
as  no  formulas  are  supposed  to  be  written  for  a  longer  period  than  three  weeks. 

Character  of  Reports  Rendered  by  Station  Employees 
During  the  demonstration  daily  reports  were  made  out  at  the  close  of  each 
day's  work,  by  both  physician  and  station  nurse,  and  mailed  to  the  central  office, 
where  daily  tabulations  were  made  and  the  results  used  for  general  supervision 
and  control. 

Nurse's  Daily  Report  Card 

The  nurse  made  her  daily  reports  on  the  card  form,  4x6  inches,  as  shown 
in  Exhibit  31. 

This  report  provides  for  reporting  the  name  of  the  nurse,  the  date,  station 
number,  hour  of  arrival,  and  hour  of  her  departure;  information  relating  to 
changes  in  the  station  enrolment  by  giving  the  cases  brought  forward  from  the 
previous  day;  the  new  babies  received,  and  from  where  they  were  received;  the 
registered  cases  terminated,  and  the  reason  for  termination,  with  the  total  number 
of  active  cases  carried  forward  to  the  next  day;  the  first  visit,  and  revisits  of  well 
babies  and  sick  babies  to  the  station;  the  number  of  first  visits  and  revisits  made 
by  the  station  nurse  to  homes  of  well  babies,  sick  babies,  babies  not  found;  the 
number  of  visits  and  revisits  of  cooperation  to  dispensaries,  hospitals,  settlements, 
private  practitioners,  charitable  organizations,  etc.,  and  the  total  number  of  first 
visits  and  revisits,  and  total  for  all  visits. 

The  form  also  provides  for  recording  the  number  of  mothers  instructed  indi- 
vidually, once  or  more  than  once,  in  the  modification  of  milk  or  other  matters 
relating  to  the  care  of  the  baby ;  the  number  of  mothers  instructed  in  classes  for 
the  first  time  and  for  two  or  more  times,  and  the  total  number  instructed. 

In  the  lower  right-hand  corner  of  the  report  is  recorded  the  number  of  babies 
fed,  the  number  of  mothers  fed,  and  the  others  fed,  and  the  total  individuals  to 
whom  milk  was  dispensed;  the  number  of  requests  for  relief,  the  number  of  cases 
where  instruction  had  been  received  to  extend  entire  relief,  partial  relief,  or  to 
refuse  or  to  discontinue  relief. 

Space  is  also  given  to  the  daily  accounting  of  milk  received  and  dispensed  by 
the  station,  recording  the  number  of  quarts  and  pints  carried  forward  from  the 
previous  day's  supply;  quantity  received  on  the  date  to  which  report  relates, 
and  the  total  amount  to  be  accounted  for;  the  quantity  dispensed  to  babies, 
mothers,  and  to  others;  quantity  transferred  to  other  stations,  spoiled,  or  left 
over,  and  the  total  quantity  accounted  for. 

The  reverse  side  of  the  report  provides  for  recording  the  name,  address,  time 
of  visit,  and  recent  action  taken,  and  the  date  of  the  next  visit  for  each  home. 
Information  is  also  recorded  relating  to  cases  transferred  to  hospitals  by  giving 
the  name,  home  address,  reason  for  transferring,  name  of  hospital,  and  the  date 
on  which  the  case  entered  the  hospital.     For  deaths  among  station  babies  the 


ESTABLISHMENT  AND  OPERATION 


159 


form  provides  for  the  name,  the  home  address,  the  cause,  the  place  where  the 
death  occurred,  and  the  date  of  death. 


Form  N— 10-/)-ll-3000 

i 

\ 

NEW   YORK    MILK   COMMITTEE 

Attendance 

First 
Visk 

Re- 
visit 

Total 

Date VV.f.fr^* /...../ ,9,,     station  Nun 

F»/^^. 

Mothers 

y 

f 

A3 

Babies,  well 

4 

7 

// 

ARRIVAL  /rrr. J ^ 

Babies,  sick     

-a/ 

^ 

DEPARTURE /^^/r^  '     ./^....y'^:"jL^ 

^fi^Fr^. 

NURSE 

Visits  to  well  babies    .  . 

/ 

4^ 

^J" 

CASES    BROUGHT    FORWARD                                                          \/J'^ 

Visits  In  sick  babies    .  . 

d 

y 

Cases 

Received 

Terminated 

Visits  to  babies  not  found 

/ 

/ 

Ref. 

Trans. 

Other 

To-.al 

Trans. 

Other 

"  Total 

Visits  of  co-operailon  .   . 

Re-admilled 

Total  visits 

/^ 

Hos.  or  Disp 

n^ 

-2^ 

Mothers  Instruct.  Iiidiv. 

.r 

J 

Board  of  Health    .... 

Other  Organization     .   . 

/ 

/ 

Mothers  Instruct. Classes 

Other  N.Y.M.C.  Station 

Babies  Fed  .   . 

3! 

Milk 

QUI. 

Pts. 

Private  Practitioner    .  . 

/ 

/ 

Mothers  Fed   . 

3 

Carried  forw'd 

-• 

Canvass    

^ 

^ 

Others  Fed  .  . 

.-^  deceived  .   .   . 

/</; 

Total     to     be 
accounted  for 

<? 

Removed 

Total  Fed     .  . 

/^2 

Refused  to  Attend    .  .   . 

Request    for 
Relief.   .   .  . 

Disp.  to  babies 

^4*7 

Disp.  to 

mothers     .   . 

J 

Entire  Relief  . 

9 

Partial  Relief . 

Transferred    . 

/ 

^ 

c 

n/ 

-2/ 

Refused  Relief 

Spriiled     .  .  . 

Discontinue 
Relief.  .  .  . 

I.eft  Over    .   . 

if 

CASES    CARRIED    FORWARD                            /  /   a* 

Total  acc'd  for 

/^ 

Action  taken 


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■<OME     ADDBFSS 


Exhibit  31 
Nurse's  Daily  Report 


i6o 


INFANT  MORTALITY  AND  MILK  STATIONS 


Daily  Report  of  Physician 
The  stations'  physicians  were  required  to  make  a  report  each  day  on  which 
services  were  rendered ;  the  form  of  this  report  is  shown  below : 


ron„P-«.,.n-i5oo                  ^^^   YORK    MILK   COMMITTEE                  - 

PHYSICIANS    DAJLY   REPORT           A            ^^          -^ 

Station  Number 

^  w. 

I^  . 

Q     Remarks 
Ajlia.g  i^c-oV    Cj9-«0?^ 

Honre 

/A  /a.. 

1 

.1  v.^' 

1 

Individual  Wohk 

Mothers  Instructed 

S3 

^0 

, 

Well  Babies  Examined    .    .    . 

3  0 

Hi 

Sick  Babies  Examined      .    .    . 

\r 

Total  Babies  Examined 

33 

^'0 

Class  Work 

No.  of  ClasBea  Held  ..... 

No.  Mothers  Present     .    .    . 

No.  Little  M.  Present  .... 

Cases  Referred 

H-p'^"{MeS:.::: 

f 

Si 

^»«Pe-^   {mcS'.  . . . 

/ 

Board  of  Health 

Outing 

J 

Central  Office      

Total 

I 

if 

Signaftire  of  Physician 

Exhibit  32 


It  gives  the  district  served  by  the  physician  and  the  date  of  the  report.  The 
column  rulings  at  the  right  of  the  items  shown  in  the  first  column  are  provided  for 
recording  separate  information  for  each  station  to  which  services  were  rendered 
by  the  physician.  The  information  called  for  relates  to  work  performed  by  the 
physician,  showing  the  hour  of  arrival  and  departure,  the  individual  work  per- 
formed by  recording  the  number  of  mothers  instructed  and  babies  examined; 
the  number  of  mothers  and  "little  mothers"  or  older  girls  present  at  consulta- 
tions. The  physician  also  reports  the  action  taken  in  referring  cases,  by  giving 
the  number  of  cases  referred  to  hospitals  and  dispensaries  and  the  reason  for 
referring;  the  number  referred  to  the  Department  of  Health,  to  private  prac- 
titioners, and  to  the  central  office,  together  with  the  total  number  of  cases  re- 
ferred. To  the  right  of  the  column  rulings  space  is  provided  for  remarks  intended 
to  be  brought  to  the  attention  of  the  central  office. 

In  addition  to  the  foregoing,  special  reports  were  rendered  by  physicians 
and  nurses  when  requested.  No  other  regular  report  except  a  weekly  financial 
statement  as  to  the  milk  and  supply  sales  was  required. 


TABLE   117.— 

SHOWING 

STATEMENT  OF 

COST  OF  OPERATING  THE  COMMITTEE'S   MILK 

STATIONS   DURING  THE   MONTH  OF  SEPTEMBER,   1911 

SUPERVISION  AND  CENTRAL  ADMINISTRATION  EXPENSES 

STATION  OPERATI 

ON  EXPENSES 

EDUCATIONAL   EXPENSES 

Grand  Total, 

i 

7. 

Salabiib 

S„.o=.™v 

TSLEPHONE 

Postage. 
Printing,  and 
Stationery 

Incidental 

total 

Salaries— Ma- 

Rent 

Gas 

,G. 

CLEANIHG 

Stationery 

Tele,»one 

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6.72 

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81.11 

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147.50 

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181.00 

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2.78 

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4.40 

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4.91 

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2.79 

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6.87 

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59.28 

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48.87 

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155.84 

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4.78 

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2.71 

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6.69 

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4.21 

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124.41 

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150.00 

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182.90 

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369.70 

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28 

104 

3,120 

22.30 

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2.78 

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1.58 

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3.89 

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33.55 

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32.50 

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11.59 

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1.10 

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1.25 

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98.32 

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15.75 

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87.18 

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103.44 

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235.31 

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1.61 

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1.05 

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102.99 

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122.50 

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146.69 

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283.84 

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114 

3,420 

27.37 

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3.03 

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1.72 

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4.25 

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36.65 

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65.00 

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32.50 

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1.66 

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5.01 

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1.34 

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109.26 

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132.50 

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156.51 

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6.98 
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109.74 

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172.63 

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$1559.99 

$1609.34 

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$1014.20 

$238.70 

$140.95 

$3274.35 

$772.20 

$3597.19 

$4393.01 

$9227.35 

1.0631 

ESTABLISHMENT  AND  OPERATION  i6i 

The  Cost  of  Operating  Milk  Stations 
The  cost  of  conducting  the  milk-station  work  may  be  divided  into  four  divi- 
sions of  expenditures  as  follows : 

1.  Supervision  and  central  administration. 

2.  Maintenance  of  milk-station  plants. 

3.  Medical  and  educational  work. 

4.  Loss  on  milk  sales  and  cost  of  relief. 

Under  expenditures  on  account  of  "supervision  and  central  administration" 
may  be  properly  included  the  salaries  of  the  administrating  official  or  officials, 
the  salaries  of  supervisors,  and  the  salaries  of  the  central  office  force,  including 
chief  clerk,  relief  agent  and  clerks,  the  cost  of  stenographic  service,  rent  of  central 
office,  telephone  service,  postage,  printing,  stationery,  office  supplies,  and  inci- 
dentals. 

The  "maintenance  of  milk-station  plants"  would  also  include  wages  of 
matrons  and  interpreters,  rental  of  stations,  gas,  ice,  cleaning,  when  not  per- 
formed by  station  matron,  postage,  printing,  stationery,  carfare,  supplies,  and 
incidental  expenses. 

The  "medical  and  educational  work"  carried  on  at  the  station  would  include 
salaries  of  nurses  and  physicians;  cost  of  printing  and  circulating  posters,  bulle- 
tins, and  circulars;  medical  and  educational  supplies,  carfare,  and  incidental 
expenses. 

"Loss  on  milk  sales  and  cost  of  relief"  represents  the  difference  between  the 
purchasing  and  the  selling  price  of  the  milk  if  it  is  sold  below  cost,  and  the  cost  of 
milk  dispensed  in  the  form  of  relief. 

Table  No.  117  is  a  statement  giving  the  distribution  of  the  expense  of  operating 
31  of  the  Committee's  milk  stations  during  the  month  of  September,  1911;  this 
month  is  taken  because  it  represents  very  nearly  the  average  monthly  expendi- 
tures during  the  period  of  demonstration.  This  analysis  will  give  an  idea  of  the 
system  employed  by  the  Committee  in  arriving  at  the  cost  of  operating  the  various 
stations. 

The  statement  is  divided  into  three  parts — i.  e.:  (a)  Supervision  and  ad- 
ministration; (b)  maintenance  of  milk  station  plants;  (c)  medical  and  educa- 
tional expenses.  Inasmuch  as  the  "loss  on  milk  sales"  is  a  constant  factor,  and 
the  relief  in  the  form  of  milk  was  extended  through  other  agencies,  these  expendi- 
tures are  not  shown  in  this  statement. 

Expenses  on  account  of  "supervision  and  central  administration "  are  charged 
to  the  different  stations  on  the  basis  of  their  enrolment,  consequently  the  amount 
shown  as  the  average  expenditure  per  baby  day  under  this  item  is  the  same  for  all 
the  stations,  although  the  actual  amounts  charged  against  the  stations  vary  by 
reason  of  the  difference  in  the  average  daily  enrolment  of  babies. 

The  total  amount  expended  during  the  month  of  September,  as  shown  by 
the  statement  on  account  of  "supervision  and  central  administration,"  was 
$1559.99,  or  an  expenditure  of  $0.0107  per  baby  day.  These  amounts  are  made 
up  as  follows: 


i62  INFANT  MORTALITY  AND  MILK  STATIONS 

AvKRAGE  Cost 
Total  per  Baby  Day 

Salaries $1037.14  .                   $0.0071 

Stenography 139.50  0.0010 

Rental  and  telephone 129.23  0.0009 

Postage,  printing,  and  stationery 73.26  0.0005 

Incidental  expenses 180.86  0.0012 

The  expense  of  "maintenance  of  milk  station  plants,"  exclusive  of  the  cost  of 
"medical  and  educational  work"  during  this  month,  was  $3274.35,  or  an  average 
of  $0.0225  per  baby  day,  made  up  as  follows : 

Average  Cost 
Total  per  Baby  Day 

Salaries  of  matrons $1609.34  $0.0111 

Rental 1014.20  0.0069 

Gas 51.52  0.0004 

Ice 238.70  0.0016 

Cleaning 140.95  0.0010 

Postage,  printing,  and  stationery 23.06  0.0001 

Telephone 92.30  0.0006 

Carfare 22.45  0.0001 

Incidental  expenses 81.83  0.0006 

Maintenance  of  Milk-Station  Plants 
The  cost  varied  considerably  among  the  different  stations.  The  amount 
spent  for  rent  varied  from  $14.10  to  $45  per  month.  The  expense  incurred  for 
cleaning  the  stations  varied  because  at  some  of  the  stations  the  matrons  did  this 
work,  while  at  other  stations  it  was  deemed  advisable  to  employ  outside  help, 
either  because  the  matron  could  be  used  to  better  advantage  in  other  ways,  or 
because  she  was  not  strong  enough  to  do  scrubbing  and  cleaning.  The  amount 
expended  for  wages  of  matrons  varied  from  $32.27  to  $91  per  station.  In  some 
stations  only  one  matron  was  required,  while  in  others  the  character  and  size  of 
the  enrolment  necessitated  two  and  sometimes  three  matrons. 

The  cost  for  "medical  and  educational  work"  represents  expenditures  of 
maintaining  the  staff  of  physicians  and  nurses  and  expenditures  incidental  to 
their  work.  The  amount  expended  under  this  heading  during  the  month  of 
September  was  $4393.01,  or  an  average  of  $0.0302  per  baby  day,  made  up  as 
follows : 

Average  Cost 
Total  per  Baby  Day 

Salaries  of  physicians $772.20  $0.0053 

Salaries  of  nurses .  3597.19  0.0247 

Posters,  bulletins,  and  circulars  for  dis- 
tribution    23.62  0.0001 

The  expenditures,  therefore,  for  the  month  of  September  may  be  summarized 
as  follows: 

Average  Cost 
Total  per  Baby  Day 

Supervision  and  central  administration  .$1559.99  $0.0107 

Maintenance  of  milk  station  plants 3274.35  0.0225 

Medical  and  educational  work 4393.01  0.0302 

$9227.35  $0.0634 


■„ 

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ESTABLISHMENT  AND  OPERATION  163 

Upon  the  basis  of  the  foregoing  statement  the  yearly  cost  for  each  baby 
supervised  by  the  milk  stations  may  be  estimated  as  $23.14,  made  up  as  follows: 

Supervision  and  administration $3.90 

Maintenance  of  milk  station  plants 8.22 

Medical  and  educational  work 11.02 

$23.14 

Physicians 

Ten  physicians  were  placed  in  charge  of  the  medical  consultation  work  of 
the  milk  stations,  two  of  whom  served  as  volunteers  at  one  consultation  per  week; 
the  others  were  paid  according  to  the  number  of  consultations  held,  their  salaries 
varying  from  $50  to  $100  a  month. 

The  Committee  was  fortunate  in  that  it  could  pay  for  this  service,  as  it 
placed  its  relations  to  the  physicians  upon  a  business  basis.  Their  work  was  in- 
spected by  the  supervising  physician,  and  they  were  required  to  conform  to  a 
uniform  scheme  of  procedure  in  discharging  their  duties.  Daily  reports  were  re- 
quired, and  punctuality  in  attendance  was  made  obligatory.  Failure  to  conform 
to  instructions  and  inaptitude  for  the  consultation  work  demanded  several  changes 
in  the  staff  during  the  demonstration. 

The  milk  station  work  calls  for  physicians  possessing  not  only  the  technic 
of  infant  feeding,  but  the  ability  and  personality  which  will  enable  them  to  reach, 
benefit,  and  hold  the  most  ignorant  mother.  It  also  requires  patience  to  do  the 
systematic  routine  and  painstaking  tasks  incidental  to  intelligent  and  scientific 
record  keeping. 

The  quality  of  the  service  rendered  by  the  medical  staff  is  evidenced  by  the 
facts  set  forth  in  the  chapter  dealing  with  the  results  achieved. 

Nurses 
All  the  nurses  appointed,  with  one  exception,  were  graduates  from  recognized 
training-schools  for  nurses.  The  nurse  appointed  without  training-school  ex- 
perience proved  unsatisfactory  after  several  weeks'  trial.  Of  the  63  nurses 
appointed,  17  gave  up  the  work  during  the  six  months'  demonstration,  either 
because  they  received  appointments  to  civil-service  positions  or  could  not  adapt 
themselves  to  the  milk-station  work.  Only  six  of  the  nurses  appointed  were 
familiar  with  any  language  other  than  English,  although  a  large  proportion  of  the 
station  enrolment  was  drawn  from  non-speaking  English  homes.  It  has  been  the 
experience  of  the  Committee  that,  with  an  interpreter  or  a  matron  familiar  with 
the  language  of  the  district,  better  results  could  be  obtained  by  employing  a 
station  nurse  of  a  different  nationality  than  that  comprising  the  station  enrolment. 
Both  the  Italian  and  the  Jewish  mothers  seem  to  have  more  confidence  in  the 
American  nurse  than  in  one  of  their  own  nationality.  A  case  in  point  is  our  ex- 
perience at  the  Third  Street  station.  This  station  was  opened  during  the  month 
of  July,  in  a  locality  largely  made  up  of  Polish  Jews.  A  nurse  of  the  same 
nationality  was  appointed,  and  began  an  active  canvass  to  build  up  the  station 
enrolment.      For   nearly  four   weeks   comparatively  little   progress  was  made, 


l64  INFANT  MORTALITY  AND  MILK  STATIONS 

although  the  district  is  densely  populated.  The  nurse  reported  that  in  spite  of 
all  she  could  do  the  mothers  would  not  consent  to  bring  their  babies  to  the  station. 
As  the  experience  of  this  nurse  was  unusual,  special  aid  was  given  her  by  the 
central  office  in  advertising  the  station  in  the  neighborhood.  At  the  end  of  four 
weeks  a  change  was  decided  upon,  and  an  American  nurse  with  no  knowledge  of 
the  neighborhood  or  its  language  took  charge  of  the  work,  with  the  result  that 
within  two  weeks  a  full  enrolment  of  babies  was  obtained,  and  this  became  one 
of  our  most  successful  stations.  Her  personality,  enthusiasm,  and  tact  were 
sufficient  to  more  than  overcome  any  handicap  caused  by  lack  of  familiarity 
with  the  language  of  the  neighborhood.  In  this  case  the  new  nurse  soon  found 
several  interpreters  from  among  the  "little  mothers"  of  the  neighborhood,  and 
one  of  them  accompanied  her  on  her  daily  rounds. 

Out  of  a  total  of  6684  nurse  days  served,  only  sixty  days'  absences  were  due 
to  illness.  When  it  is  considered  that  this  service  was  rendered  during  the  six 
months  of  the  most  tedious  and  trying  season  of  the  year,  the  absence  on  account 
of  illness  is  remarkably  low,  and  can  be  attributed  only  to  the  keen  interest  and 
sense  of  responsibility  of  the  nurses,  which  made  them  feel  that  absences  from 
their  stations  might  mean  disaster  to  some  of  the  lives  intrusted  to  their  care. 
Their  devotion  to  the  work  is  further  manifested  by  the  fact  that  the  time  record 
shows  the  nurses  to  have  given  2441  hours,  or  349  nurse  days,  in  overtime  and 
Sundays,  without  extra  remuneration. 

Matrons 

The  matrons  or  nurses'  assistants  were  chosen  from  a  list  of  185  applicants. 
Of  these,  68  appointments  were  made  during  the  period  of  the  demonstration. 
Preference  was  given  to  capable  applicants  residing  in  the  locality  of  the  station 
and  speaking  the  language  of  the  prospective  station  enrolment. 

The  duties  of  the  matron  were  so  varied  that  it  was  a  problem  to  obtain  the 
right  kind  of  women.  They  were  required  to  be  able  to  keep  a  record  of  milk 
sales,  to  attract  mothers  to  the  stations,  to  be  neat  in  their  work,  which  included 
mopping,  dusting,  and  keeping  ice-box  and  utensils  scrupulously  clean,  and  to 
render  general  assistance  to  the  physician  and  nurse  in  the  instruction  of  mothers. 
Some  of  the  older  matrons  with  personal  maternal  experience  proved  unsatis- 
factory because  they  persisted  in  instructing  the  mothers  in  their  own  language 
according  to  their  own  ideas,  and  otherwise  undermining  the  influence  of  the 
physician  and  nurse. 

Only  15  of  the  68  appointments  made  for  matrons  were  given  to  American- 
born  women;  the  other  appointments  were  given  to  Italian,  Hebrew,  German, 
Hungarian,  Polish,  and  Bohemian  applicants. 

Out  of  6614  days  served  by  matrons,  only  49  absences  were  due  to  illness. 
As  a  rule,  the  same  devotion  and  enthusiasm  which  prevailed  among  the  nurses 
marked  the  work  of  the  matrons. 


CHAPTER  X 

Extension  of  Milk  Station  Activities 

The  milk  station  has  demonstrated  what  can  be  done  in  preventing  sickness 
and  useless  waste  of  infant  life  through  the  education  of  mothers  in  the  feeding 
of  their  babies.  As  the  station  organization  and  methods  become  perfected 
greater  results  may  reasonably  be  expected. 

This  chapter  will  show  how  the  milk  station  can  be  made  the  basis  for — 

1.  The  prevention  of  deaths  of  early  infancy  due  to  the  lack  of  proper 

prenatal  care. 

2.  The  official  supervision  and  control  of  midwives. 

3.  The  official  supervision  and  control  of  foster  mothers  having  boarded- 

out  babies. 

4.  The  education  of  mothers  in  the  care  of  children  under  school  age. 
All  these  activities  may  be  properly  carried  on  by  the  milk  stations  estab- 
lished and  maintained  by  the  city,  while  stations  conducted  by  private  agencies 
may  eventually  be  expected  to  make  the  education  of  expectant  mothers  and  the 
supervision  of  children  under  school  age  a  regular  feature  of  their  work. 

The  following  table  shows  the  main  causes  of  deaths  among  infants  before 
they  reached  one  year  of  age,  and  the  rate  per  thousand  in  each  case: 

TABLE  118.— INFANT  DEATHS,  CAUSES,  AND  PROPORTION  (NEW  YORK  CITY,  1909) 

Congenital  debility,  malformations,  and  ill- 
defined  causes  of  early  infancy 326  Out  of  1000  deaths 

Diseases  of  digestive  system 282  " 

Diseases  of  respiratory  system 232  " 

Infection,  contagion,  and  tuberculosis 94  " 

Diseases  of  nervous  system 42  " 

All  other  causes 25  " 

The  first  three  main  causes  account  for  85  per  cent,  of  the  total  infant  mor- 
tality in  New  York  city.  It  is  not  comforting  to  know  that  these  deaths  are 
largely  preventable;  that  out  of  every  1000  infant  deaths  326  are  due  in  a  great 
measure  to  the  lack  of  prenatal  care  as  a  result  of  ignorance  and  social  sins ;  282 
are  largely  due  to  ignorance  and  bad  food,  and  232  are  mainly  due  to  ignorance 
and  bad  air.  In  all  these  causes  ignorance  must  be  given  the  first  place;  hence 
the  solution  of  the  problem  lies  in  education. 

The  systematic  instruction  by  which  the  expectant  mother  will  come  to  act 
intelligently  and  wisely  in  the  care  of  herself  will  not  only  enable  her  to  produce 
a  better  and  healthier  baby,  but  will  help  her  to  nurse  the  baby  as  nature  in- 
tended. The  fact,  therefore,  of  starting  the  education  of  the  mother  before  the 
baby  arrives  will  not  only  reduce  the  infant  death-rate  from  congenital  diseases, 
but  will  afford  an  additional  means  of  reducing  the  death-rate  from  enteritis. 

165 


i66  INFANT  MORTALITY  AND  MILK  STATIONS 

The  following  table  shows  the  reasons  for  terminating  breast-feeding  in  the  case 
of  1656  milk-station  babies  artificially  fed  before  they  reached  the  age  of  nine 
months : 

TABLE  119.— REASONS  FOR  ARTIFICIAL  FEEDING 

Number  Per  Cent. 

Artificially  fed  under  nine  months 1656  100.0 

Insufficient  milk 330  19.9 

Mother  ill _. 258  15.5 

Weaned,  mother  not  willing  to  nurse.  ...   210  13.8 

Mother  working 204  13.3 

Abnormalities  of  breasts 176  10.6 

Mother  dead 170  10.3 

Mother's  milk  "does  not  agree" 159  9.7 

Mother  pregnant 149  9.8 

The  resorting  to  artificial  feeding  because  of  lack  of  milk,  ill  health,  and  ab- 
normalities of  breasts  constituted  46  per  cent,  of  the  reasons  for  depriving  the 
baby  of  its  right  to  nurse,  and  thereby  lessening  its  chances  to  live  through  the 
first  year  of  life. 

The  milk  station  offers  a  means  of  not  only  reaching  the  expectant  mother 
several  months  prior  to  confinement,  but  affords  facilities  by  which  she  may  be 
successfully  instructed  in  the  hygiene  of  pregnancy. 

This  Committee  began  an  experiment  during  the  early  part  of  last  summer 
which  would  cover  several  thousand  expectant  mother  cases,  to  determine  the 
best  working  method  by  which  the  milk  station  could  be  utilized  in  educating  the 
expectant  mother.  The  nurses  were  enthusiastic  over  this  feature  of  the  work, 
and  within  a  few  weeks  nearly  1000  cases  were  regularly  registered  at  the  stations 
and  were  receiving  instructions.  The  milk  station  gives  the  nurse  and  physician 
the  best  and  most  delicate  means  of  approaching  the  mother  on  the  subject. 
Nearly  15  per  cent,  of  the  expectant  mothers  registered  was  made  up  of  primipara 
cases,  showing  that  even  the  young  married  woman  was  interested  and  came  to 
confide  her  secret  to  the  station  nurse  and  receive  advice.  The  following  popular 
little  letter  was  distributed  with  good  effect  to  10,000  mothers,  and  read  by  them 
in  their  native  tongues.     (Exhibit  34.) 

The  leaflet  containing  this  letter  gave  a  list  of  milk  stations,  as  also  a  list 
of  hospitals  receiving  maternity  cases  and  hospitals  and  dispensaries  maintaining 
outdoor  departments.  Furthermore,  5000  circulars  on  the  "  Prevention  of  Blind- 
ness" (published  by  the  Society  for  the  Prevention  of  Blindness)  were  distributed 
through  the  milk  station  in  order  to  warn  mothers  of  the  danger  of  improper  care 
at  confinement. 

Expectant  Mothers  Registered  at  Milk  Stations 
The  31  stations  of  the  Committee  were  used  as  centers  where  expectant 
mothers  were  registered,  many  of  them  already  having  a  baby  under  the  super- 
vision of  the  milk  station.  Those  not  having  babies  registered  at  the  station 
were  brought  under  its  influence  by  the  nurse  while  visiting  the  home,  and  by  being 
referred  to  the  station  by  mothers  already  registered.  For  each  expectant  mother 
with  whom  the  nurse  came  in  contact  a  special  card  was  made  out.    (Exhibit  35.) 


EXTENSION  OF  MILK  STATION  ACTIVITIES  167 


A  LETTER  TO  EXPECTANT  MOTHERS 

Dear  Mothers: 

Last  year  fully  five  thousand  babies  died  in  New  York  before  they 
were  one  month  old.  They  died  because  they  were  born  too  weak  to 
combat  the  diseases  of  babyhood.  They  were  born  weak  because  their 
mothers  did  not  properly  care  for  themselves  during  the  period  of  preg- 
nancy; overwork,  lack  of  exercise,  insufficient  or  improper  nourishment, 
irregularity  in  eating  and  sleeping,  worry  and  nervousness  were  some  of 
the  many  causes. 

Every  mother  desires  to  have  her  baby  born  healthy  and  strong. 
Every  baby  has  a  right  to  be  so  born.  You  can  do  much  at  this  time 
to  insure  your  baby  being  born  well  and  strong.  Prepare  yourself  in 
advance — be  regular  in  your  habits ;  build  yourself  up  by  eating  whole- 
some food;  avoid  beer,  whiskey  and  drugs;  talk  to  your  doctor  about 
yourself,  or  go  to  any  BABIES'  PURE  MILK  AND  HEALTH 
STATION  for  advice. 

When  the  time  comes  for  the  baby  to  be  born,  you  must  use  special 
care  so  as  not  to  have  your  own  health  or  that  of  your  baby  impaired. 
Remember  that  one-half  of  all  the  blindness  in  this  world  is  due  to  im- 
proper care  of  the  baby's  eyes  immediately  after  birth. 

To  avoid  having  your  own  health  and  that  of  your  baby  impaired  at 
the  time  of  birth,  you  will  need  special  care.  Obtain  the  best.  It  will 
be  worth  while.  If  you  can  go  to  the  hospital,  do  so  by  all  means; 
there  you  will  receive  proper  medical  and  nursing  care  for  yourself  and 
baby.  Select  from  the  list  of  hospitals  given  in  this  circular  the  one  to 
which  you  desire  to  apply  for  admission,  and  make  arrangements  at 
least  two  weeks  in  advance  of  the  date  of  confinement.  If  you  cannot 
leave  your  home  because  of  other  children,  go  to  a  "Blue  Front" 
BABIES'  PURE  MILK  AND  HEALTH  STATION  for  advice;  there 
the  nurse  will  be  glad  to  tell  you  of  hospitals  and  settlements  which  will 
provide  medical  treatment  and  nurse  services  in  your  own  home.  Many 
agencies  will  furnish  women  physicians  if  desired.  These  services  can 
be  obtained  at  a  small  charge,  or  free  if  you  cannot  afford  to  pay. 

Do  not  forget  you  owe  it  to  your  unborn  babe  to  bring  it  into  the 
world  well  and  strong.   This  you  can  do  if  only  you  are  willing  to  learn  how. 


Exhibit  34 

This  card  is  a  distinctive  blue  color,  a,nd  was  filed  at  the  station  under  the 
month  in  which  the  confinement  was  expected  to  take  place. 

Two  nurses  were  employed  especially  for  following  up  these  cases  and  giving 
the  expectant  mothers  the  proper  instruction — this  was  in  addition  to  the  general 
instruction  given  by  the  station  nurse.  When  the  special  nurse  visited  the  home, 
a  more  detailed  history  of  the  case  was  obtained.  The  form  of  this  record  is 
shown  in  Exhibit  36. 

These  were  then  forwarded  to  the  central  office,  where  they  were  classified 
as  to  the  necessary  attention  which  the  case  would  require,  and  filed  under  date 
of  next  visit  for  the  purpose  of  instruction  or  for  the  completion  of  the  record. 


i68 


INFANT  MORTALITY  AND  MILK  STATIONS 


Ob 

8  0 

V    w 


EXPECTANT  MOTHER 

Name Age 

Address Flight frt.  bok.  rt.  1ft.  rr.  house 

By  Whom  Referred 

Date  Expected  Confinement Hospital Home 

Medical  Supervision Other  Supervision 

Family  consists  of  Husband Children Ages 

Home  Conditions:   Good.... Fair.... Bad Mother's  Health:. ...Good. ...Fair.. ..Bad 

Referred  to    

Remarks 

Dates  Visited By  Whom 


Exhibit  35 


COMMmEE    FOR    THE    REDUCTION    OF    INFANT   MORTALITY 

OF  THE 

NEW   YORK    MILK   COMMITTEE 
EXPECTANT   MOTHER 

Name  <rf  Mother 

Address                                               Age 

Where  Bora 

Kind  of  Work                                                                                       Place 

History  of  Previous 
Indicated  by 
M — Miscarriage 
P— Premature 
N— Normal  Birth 
S— sun  Birth 
T — Twins 

(Factory,  Si  ore.  Home,  etc  ) 

Pregnancies               ijt 
Age  at  Death 

2nd 

3rd 

4th 

Sth 

6th 

7th 
Age  at  Death 

Stb 

9th 

10th 

nth 

12th 

Date  Stc.j-ped  Work  before  present  Confinement                              Date  Began  Work  after  present  Confinement 

Date  of  Birth 

Normal              Place                       Attendant  at  Birth  (Check  i  Physician Midwife Nurse 

Date  of  Death 

lYesorNo)        (Hospital  or  Home) 

Cause                                      Baby's  Health  after  1  Month  old.           Good Poor 

Breast  Fed 

Bottle  Fed                                      Date  Registered  at  Station 

Date  of  Report 

NURSE       1 

Exhibit  36 


EXTENSION  OF  MILK  STATION  ACTIVITIES  169 

A  careful  canvass  was  made  to  ascertain  the  requirements  for  admittance 
at  lying-in  hospitals,  and  facilities  available  for  rendering  service  at  confinement 
in  the  homes.  Dispensaries  were  visited  and  arrangements  were  made  for  sending 
patients  for  preliminary  examinations.  The  card  form  shown  below  was  used 
in  referring  cases  to  the  various  agencies  rendering  services  to  pregnant  women : 


COMMITTEE  FOR  THE   REDUCTION  OF  INFANT  MORTALITY 

OF  THE 

NEW  YORK  MILK  COMMITTEE 


191 

To 


The  bearer  Mrs. 


living  at is  hereby  referred  to  you 

for . 

(Station  stamp  here)  


Exhibit  37 

Much  valuable  assistance  was  given  by  district  nurses  from  various  settle- 
ments. Relief  agencies  came  to  the  rescue  where  the  home  conditions  were  de- 
plorable and  mothers  sick  or  undernourished  by  reason  of  poverty. 

Character  of  Instruction  to  Expectant  Mothers 
Every  endeavor  was  made  to  obtain  the  enrolment  of  the  cases  before  the 
sixth  month  of  pregnancy;  this  was  not  always  possible,  yet  essential  if  the  in- 
struction was  to  be  thorough  and  effective. 

The  character  of  the  instruction  varied  according  to  existing  conditions. 
The  improperly  nourished  were  especially  advised  as  to  diet,  while  the  sick  were 
placed  under  medical  care.  The  health  of  the  mother  was  given  first  considera- 
tion, and  all  possible  means  were  employed  to  improve  her  general  health;  this 
included  instruction  as  to  her  habits,  daily  routine,  exercise,  diet,  condition  of 
bowels,  clothing,  etc.  In  every  case  the  kind  and  amount  of  instruction  were  de- 
pendent upon  the  difficulties  which  the  case  presented.  This  of  necessity  left 
much  to  the  discretion  of  the  nurse,  and  in  order  to  have  the  cases  handled  as 


170  INFANT  MORTALITY  AND  MILK  STATIONS 

uniformly  as  possible,  the  special  nurses  visited  each  case  in  the  home  after  the 
preliminary  instruction  had  been  given  by  the  station  nurse. 

The  special  nurses  were  selected  for  their  tact  and  ability  to  instruct  the 
mothers.  They  continued  the  visiting  and  instructing  until  the  baby  had  reached 
one  month  of  age,  when  the  case  was  referred  to  the  nearest  milk  station.  The 
results  obtained  in  this  work  with  500  expectant  mothers  are  encouraging.  They 
are  not  given  because  the  number  is  too  small  to  prove  conclusively  the  value  of 
prenatal  instruction  in  reducing  infant  mortality  in  New  York.  Furthermore, 
this  work  was  merely  preliminary  to  determine  the  best  working  organization 
methods  and  records  for  an  intensive  study  and  experiment  along  this  line  during 
1912. 

The  Milk  Station  as  a  Basis  for  Official  Control  Over  Midwives 
The  midwife  has  been  condemned  as  incompetent  and  dangerous  to  both 
mother  and  baby  by  her  slovenly  and  ignorant  ways.  She  has  had  many  accusers 
and  few  loud  defenders.  Attempts  have  been  made  to  bring  her  under  rigid 
official  supervision.  She  is  required  to  have  a  permit  to  practise,  and  she  must 
comply  with  certain  regulations,  one  of  which  is  to  have  a  proper  outfit  for  caring 
for  her  cases.  She  is  visited  occasionally  in  her  home  by  an  inspector  from  the 
Health  Department,  just  for  what  purpose  it  is  difficult  to  understand,  unless  it 
is  to  see  if  she  still  has  her  license  and  outfit.  At  first  these  official  visits  caused 
her  not  a  little  concern,  but  she  soon  began  to  see  that  they  were  merely  formal; 
the  possession  of  a  clean  outfit,  license,  and  ready  answers  to  routine  questions 
are  now  rarely  lacking. 

The  milk  station  offers  a  medium  for  exerting  adequate  control  over  the 
midwife.  Her  license  or  permit  should  be  issued  through  the  milk  station  nearest 
her  home;  she  should  be  made  to  feel  that  a  renewal  of  the  permit  depends 
largely  upon  her  ability  to  demonstrate  to  the  station  nurse  and  physician  that 
she  has  not  only  performed  her  own  work  well,  but  has  actively  cooperated  in 
advancing  the  municipal  milk  station  work.  The  mutual  advantage  in  bringing 
the  midwife  in  touch  with  the  station  nurse  and  her  work  is  apparent. 

The  Milk  Station  as  a  Basis  for  Supervision  of  Boarded-out  Babies 
The  relation  of  the  foundling  and  boarded-out  baby  to  the  infant  mortality 
rate  is  an  important  one.  The  official  supervision  of  these  babies  i§  intrusted 
to  the  Health  Department,  and  is  part  of  the  work  of  the  Division  of  Child 
Hygiene.  Foster  mothers  are  required  to  take  out  permits  from  the  Depart- 
ment, which  are  issued  after  inspection  of  the  premises,  and  visits  are  supposed 
to  be  made  at  regular  intervals  by  inspectors.  At  best  these  inspections  can  be 
only  at  considerable  intervals,  and  it  is  doubtful  if  the  supervision  can  be  ade- 
quate. It  is  also  undoubtedly  true  that  a  considerable  number  of  babies  are 
living  with  foster  mothers  of  whom  the  Health  Department  has  no  record,  and 
over  whom  it  can  exert  no  supervision. 

The  majority  of  these  babies  come  from  two  institutions  in  this  city  which 
maintain  their  own  inspection  service  in  addition  to  that  maintained  by  the 


Under  School  Age.  A  Problem  to  be  Solved 


EXTENSION  OF  MILK  STATION  ACTIVITIES  171 

Health  Department.  That  the  mortality  among  the  charges  of  these  institutions 
is  high  may  be  gathered  from  the  following  figures,  published  by  one  of  them.  In 
1908,  among  2190  admissions  under  one  year,  there  were  1097  deaths,  or  a  mor- 
tality of  49.2  per  cent.;  in  1909,  2237  admissions,  with  1253  deaths,  or  56.5  per 
cent,  mortality.  In  fairness  it  must  be  remembered  that  a  very  large  proportion 
of  these  babies  are  illegitimate,  and  have  already  been  deprived  of  the  breast  on 
admission.  Figures  recently  published  show  that  in  certain  European  institu- 
tions of  a  similar  character  the  mortality  is  high,  and  in  some  cases  higher,*  but 
this  does  not  mean  necessarily  that  it  cannot  be  lowered. 

The  establishment  of  municipal  milk  stations  throughout  the  city  opens  the 
way  for  bringing  boarded-out  babies  under  a  more  thorough  and  effective  system 
of  supervision,  by  making  the  milk  station  the  headquarters  in  each  district  for 
officially  dealing  with  such  babies  and  their  foster  mothers.  A  record  of  foster 
mothers  in  the  district  could  be  kept  at  each  milk  station,  and  the  home  super- 
vision carried  on  by  the  nurse.  It  could  also  be  made  mandatory  for  the  foster 
mother  to  bring  her  baby  to  the  milk  station  at  regular  intervals  for  examination 
by  the  station  physician.  The  control  could  be  made  even  more  effective  if 
the  agency  at  whose  expense  the  baby  is  being  boarded  out  were  to  demand  a 
record  of  attendance  before  payment  for  board  is  made. 

During  the  summer  of  1911  a  number  of  babies  placed  out  by  the  two  large 
institutions  were  referred  to  the  milk  stations  for  supervision,  and  the  results 
showed  that  this  can  be  carried  on  without  interfering  with  the  authority  of  the 
institutions  over  their  charges.  Both  institutions  require  that  babies  who  be- 
come sick  shall  be  returned  for  treatment,  and  this  relation  with  the  milk  station 
should  insure  their  return  before  they  become  desperately  sick,  and  should  also 
give  the  institution  valuable  information  as  to  the  care  being  given  its  charges. 
It  would  save  the  Health  Department  much  time  and  labor  expended  by  its 
inspectors  in  following  up  the  cases  all  over  the  city,  and  make  the  supervision 
more  thorough  and  economical. 

The  Milk  Station  as  a  Basis  of  Supervision  for  Children  Under  School 

Age 
Once  a  child  reaches  school  age  and  is  enrolled  in  a  public  school,  its  mental 
and  physical  development  becomes  a  matter  of  public  concern.  Modern  school 
plants  with  every  facility  for  safeguarding  its  life  are  provided.  Trained  teachers 
undertake  its  education;  physicians  employed  by  the  city  examine  the  child  at 
regular  intervals  to  discover  any  physical  defect  that  may  endanger  its  health 
or  retard  its  progress  in  school.  Whenever  necessary,  municipal  nurses  go  to  the 
home  to  advise  the  parent  as  to  its  care  and  to  bring  about  the  proper  treatment 
to  remove  any  physical  defect.  Municipal  playgrounds  and  public  baths  are 
maintained  for  the  children's  use  and  enjoyment;  but  little,  if  anything,  has  been 
done  by  the  municipality  to  safeguard  the  lives  and  promote  the  health  among 

*  "Der  gegenwartige  Stand  der  Frage  iiber  die  Kindersterblichkeit  in  Russland  und  deren 
Bekampfung, "  Hubert,  "Archiv  f.  Kinderheilkunde,"  1912,  Bd.  Ivii,  p.  351. 


172  INFANT  MORTALITY  AND  MILK  STATIONS 

that  portion  of  our  population  represented  by  children  between  the  second  and 
sixth  years  of  life. 

A  beginning  has  already  been  made  to  exert  ofHcial  supervision  of  the  infant 
population  by  establishing  municipal  milk  stations  with  physicians  and  nurses 
to  educate  mothers  in  the  care  and  feeding  of  their  babies,  but  no  comprehensive 
plan  has  been  adopted  by  the  city  to  make  certain  that  the  child  coming  to  the 
public  school  for  the  first  time  is  not  handicapped  by  unnecessary  physical  and 
mental  defects.  Wherever  careful  physical  examinations  have  been  made  of  the 
first-year  pupils  in  our  public  schools,  one  child  out  of  every  three  has  been  found 
to  have  some  physical  defect  needing  attention.  In  many  instances  these  de- 
fects have  already  impaired  the  general  health  of  the  child  and  have  acted  as  a 
serious  handicap  to  its  proper  development.  It  is  certain,  therefore,  that  if  the 
condition  of  the  child  had  been  made  known  to  the  parents  before  it  reached 
school  age  and  the  defect  treated  or  removed,  it  would  not  only  make  possible 
a  better  first-year  pupil,  but  in  all  probability  would  insure  against  its  becoming 
a  repeater  in  the  grades. 

Milk  stations  offer  the  basis  for  officially  reaching  and  supervising  the  child 
under  school  age,  not  only  to  bring  about  the  correction  of  physical  defects,  but 
to  educate  the  mothers  in  those  things  which  will  enable  her  to  rear  a  healthy  and 
well-developed  child.  During  the  past  year  a  start  was  made  to  ascertain  what 
could  be  done  through  the  milk  stations  with  this  class  of  children,  but  no  attempt 
was  made  to  make  this  a  prominent  feature  of  the  work  of  the  milk  station. 
According  to  information  obtained  by  the  Association  of  Infant  Milk  Stations, 
about  1200  of  these  older  children  came  under  the  supervision  of  the  milk  station 
physicians  and  nurses,  largely  from  homes  having  babies  registered  at  the  sta- 
tions. In  most  of  the  stations  the  older  children  given  attention  were  those  in 
poor  health  or  seriously  in  need  of  special  care.  In  such  cases  suggestions  were 
given  to  the  mothers  as  to  their  care  and  treatment.  Nearly  150,000  quarts  of 
milk  were  dispensed  by  the  various  milk  stations  to  this  class  of  children. 

In  the  Committee's  stations  children  between  two  and  six  years  of  age,  who 
were  in  poor  physical  health,  were  carried  on  a  separate  register  from  the  station 
babies.  The  total  number  of  cases  which  came  under  the  attention  of  the  station 
nurse  were  541.  Of  these,  the  diet  of  432  was  supplemented  by  milk  furnished 
by  the  station  and  paid  for  by  the  mothers  or  by  relief  agencies  to  whose  attention 
some  of  the  cases  were  brought.  The  medical  examination  of  these  children  has 
shown  that  248,  or  46  per  cent.,  of  the  number  registered  were  in  need  of  medical 
attention,  and  were  referred  to  the  proper  agency  for  treatment;  6  cases  were  sent 
to  hospitals  for  surgical  operations;  18  entered  hospitals  for  medical  care.  In 
most  instances  children  receiving  hospital  or  dispensary  care  were  later  referred 
by  the  station  nurse  to  agencies  prepared  to  furnish  country  outings.  Of  the 
541  children  registered,  284  were  sent  to  the  country  through  the  cooperation  of 
these  agencies. 

The  mothers  were  carefully  instructed  as  to  the  care  of  the  older  children 
during  the  visit  of  the  nurse  to  the  home.  A  special  diet  card  was  prepared  by 
Dr.  Godfrey  R.  Pisek  during  the  early  part  of  the  summer,  and  a  large  number 


COMMITIEE  FOR  THE  REDUCTION  OF  INFANT  MORTALITY 
NEW  YORK  MUK  COMMITTEE 


COMMITTEE  FOB  THE  REDUCTION  OP  INFANT, MORTALITY 
NEW  YORK  MILK  COMMITTEE 


DIET  FOR  CHILD 

FROM    <2TH   TO    J6TH   MONTH 


FIRST  MEAL-ON  RISDMG. 

(1)  1  to  2  ounces  juice  of  a  sweet  orange 
Pulp  of  6  stewed  prunes 

I  ounce  pineapple  juice.  , 

(2)  S  ounces  milk   with   cither   zwieback,  or  toasted  biscuits 

or  stale  toasted  bread. 

piOTEi     Fruit    must    be    given    eithtf    '■   hour    before 
or  }■>  hour  after  milk. 

SECOND  MEAL-DXmiNG  FORENOON. 
Milfc  alone  or  with  zwieback. 

NOON  MEAL. 

(1)  6  ounces  soup 

3  ounces  beef  juice. 

NOTE:     Soup  msy  be  made  of  chicken,  beef  or  mutton. 

(2)  Stale  bread  may  be  added  to  the  above. 

FOURTH  MEAL- AFTERNOON. 
Milk  or  toasted  bread  and  milk. 

EVENING  HEAL. 
(I)     4  ounces  thick  gruel  mixed  with  4  ounces  top  half  milk. 


NOTE:     Crutlr 
hominy 

„«  be  made  ol  oa 
,  whcatina.  or  ric 

nicji.  farina,  barlev. 

(2)    Apple  saJce 

Prone  jelly. 

Total  milk  i 

o  I.' J  quarts. 

n  24  hours.  1 

NOTE.     8 

ounces  IS  equ 

a  haJl  Pint. 

DIET  FOR  CHILD 

FROM    J8TH    TO    24TH    MONTH 

BREAKFAST. 
Jttice  of   I  sweet  orange 

Pulp  of  6  stewed  prunes 

Pineapple  juice  (fresh  or  bottled)   I  ounce. 

A  rereal  such  as  cream  of  wheat,  oatmeal,  farina,  o 
hominy  preparations  with  top  milk  (top  16  ounces 
sweetened  or  salted.  A  glass  of  milk,  bread  and  buttei 
NOTE:     If  constipated  give  the  fruits  '  ,  hour  before  break- 


,  they  I 


either  ' 


1  duri 


r  before 


FORENOON. 

A  glass  of  milk  with  two  toasted  biscui 
graham  crackers. 

ts  or  zwieback  or 

DINNER. 

.  1 1     Broth  or  soup   made   of   beef,   mutton, 
thickened  with  peas,  farina,  sago  or 

or    chicken,    and 

Beef  'juice  with    stale    bread   crumbs;    c 
soup  with  yolk  of  egg 

r  clear  7CgetabIe 

Egg  soft  boiled,  with  bread  crumbs,  or 
with  a  glass  of  milk- 

the  egg  poached. 

t2i     Dessert:    apple  sauce,  prune  pulp,  with 
or  graham   wafers 

stale  lady-fingerB 

Plain  pt<3dings;  rice,  bread,  tapioca,  blanc-mange,  junket 
,or  baked  custard. 

SUPPER. 

Glass  of  milk,  warm  or  cold;  iwieback  and 
fruit. 

custard  or  slewed 
rts. 

Total  milk  ih  24  hours.   I  >  .  qu. 

COMMITTEE  FOR  THE  REDUCTION  OF  INFANT  MORTALIIY 
NEHf  YORK  MILK  COMMITTEE 

DIET  FOR  CHILD 

FROM    TWO    TO    THREE    YEARS 


'BREAKFAST. 

Juice  of  I  sweet  orj^rtgc 

Pulp  of  6  stewed  prunes 

I  ounce  pineapple  juice  (fresh  or  bottled) 

A  cereal  such  as  oatmeal,  farina,  cream  of  wheat,  hominy 
or  rice,  slightly  sweetened  or  salted  as  preferred,  with 
the  addition  of  top  milk  (top  16  ounces) 

A  soft  boiled  or  poached  egg  with   stale  bread   or   toast. 

A  glass  of  milk. 

NOTE:     If  constipated  kJvc  the  fruits  ].i  hour  before  break- 
erj    if  not.  they  may  be  given   during  tte 


fOT€ 


7  fruit 


DINNER. 
Broth  or  soup  made  of  chicken,  mutton  or  beef,  thickened 
with  arrowroot,  split    peas,    rice,  or    with    addition    of 
the  yolk  of  an  egg  or  toast  squares. 

Scraped   beef    or  white    meat  of    chicken  or    broiled    fish 


all  , 


nt) 


Mashed   or   baked    potato  with    fresh    peas  or  spinach  or 

Dessert:     apple  sauce,  baked  apple,  rice  pixdding,  Jtinket 

or  custard. 

SUPPER. 
A  cereal  or  egg  (if  egg  is  not  taken  with  breakfast)  with 

stale  bread  or  toast 

Bread  and  milk  or  bread  and  cocoa  or  bread  and  custard. 
Stewed  fruit. 


COMMITTEE 'FOR  THE  PEDUCTION  OF  INFANT  MOPTAtlTY' 
.VEW  YORK  MH-K  COMMITTEE 

DIET  FOR  CHILD 

FROM    THREE    TO    SIX    YEARS 


BREAKFAST. 
Fruits:    an  orange,  apple,  pear  or  stewed  prunes. 

Cereal :    oatmeal,    hominy,    rice    or     wheat    preparations, 
well  cooked  and   salted,  with   thin   cream   and   sugar 

Egg:    soft  boiled,  poached,  omelet  or  scrambled. 
Mjlk  or  cocoa. 

DINNER. 
Soup:    beef,  chicken  or  mutton. 

Meat:    chicken  or  beefsteak  or  roast  beef  or  Iamb  chops 
or  fish. 

Vegetables:     spinach    or    carrots    or     si  ring -beans,    peas. 

cauIiHowcr    tops,  mashed    or   baked    potato,    beets    or 

lettuce  (without  vinegar). 
Macaroni,  spaghetti. 

Bread  and  butter     not  fresh  bread  or  rolls. 
Dessert:     custard,   rice   or  bread  or    tapioca   pudding,   icc 

cream    (once    a    week),  cornstarch   pudding  (chocolate 

or  other  flavor),  slewed  prunes,  or  baked  apple. 

SUPPER. 


A  thick  soup,  as  pea. 
butler 


A  cereal  and  thin  creai 
Stewed  Iruit:   cusljrd  i 


■earn  of  celery  with  bread  and 

(.Ih  bread  and  butler. 

I   plain   puddinR:  jam  or   jelly.. 


Exhibit  38 
Suggestions  for  Diet  for  the  Older  Children,  Distributed  Through  Milk  Stations 


EXTENSION  OF  MILK  STATION  ACTIVITIES  173 

of  these  were  distributed  by  the  milk  station  nurses.  (See  Exhibit  38.)  These 
special  diet  cards  gave  suggestions  for  each  meal  for  children  of  different  ages; 
for  example,  the  diet  card  relating  to  children  from  twelve  to  eighteen  months 
gave  suggestions  for  the  first  meal  on  rising;  the  second  meal  during  the  fore- 
noon; the  noon  meal;  the  fourth  meal  during  the  afternoon,  and  the  evening 
meal,  and  the  total  amount  of  milk  which  should  be  given  during  the  twenty- 
four  hours.  Similarly,  the  diet  is  prescribed  for  children  from  the  eighteenth 
to  the  twenty-fourth  month,  two  to  three  and  three  to  six  years  of  age.  For  the 
child  of  two  to  three  years  the  mother  is  told  that  the  breakfast  should  consist 
of  fruit,  cereal,  and  milk,  or  fruit  with  soft-boiled  or  poached  egg,  with  stale 
bread  or  toast  and  milk.  She  is  told  that  if  the  child  is  constipated,  to  give  fruits 
one-half  hour  before  breakfast  with  water,  and  if  not,  the  raw  fruit  may  be  given 
during  the  forenoon,  and  that  milk  and  raw  fruit- juice  must  not  be  given  at  the 
same  meal.  That  the  diet  of  the  midday  meal  should  consist  of  broth  or  soup, 
meat  or  fish,  vegetable,  and  dessert.  The  kinds  of  soup  or  broths  are  given,  as  is 
also  suggested  the  kind  of  meat,  vegetable  and  dessert.  For  the  evening  meal, 
a  diet  of  cereal  or  eggs  with  stale  bread  or  toast ;  or  bread  and  milk ;  or  bread  and 
cocoa;  or  bread  and  custard  and  stewed  fruit  are  prescribed.  It  is  difficult 
to  estimate  the  amount  of  good  the  distribution  of  these  diet-cards  did,  but  the 
mothers  seemed  glad  to  receive  them,  and  in  many  instances  followed  the  direc- 
tions explicitly,  particularly  in  those  cases  where  the  children  were  in  delicate 
health.  The  influence  of  the  milk  station  in  promoting  the  health  and  welfare 
of  the  older  children  cannot  be  overestimated. 


Appendix 


COMPARISON  BETWEEN  THE  BACTERIA  CONTENT  OF  MILK  DISPENSED  BY  THE 

MUNICIPAL  MILK  STATIONS  AND  THAT  DISPENSED  BY  THE  NEW  YORK 

MILK  COMMITTEE  STATIONS 

Period,  August  22  to  September  9,  1911 

The  municipal  stations  dispensed  pasteurized  milk  and  the  New  York  Milk 
Committee  dispensed  raw  milk  from  tuberculin-tested  herds.  In  both  cases 
samples  were  collected  and  examined  by  the  same  laboratory. 


New  York  Milk  Committee  Stations 


Municipal  Milk  Stations 


Date 

Aug 


Sept 


Bacteria  content  per  c.c.  Bacteria  content  per  c.c. 

22 28,500 15,000 

22 8,900 

22 12,500. 

22 12,000. 

22 6,200. 


,000 12,500 

37,000 

16,000 

17,000 

22,000 


1 

1 

1 

1 

2 

2 25,000 

2 

2 

5 

5 

5 

5 

5 


14,000 

9,500 

6,000 24,000 

8,300 10,000 

5,500 15,000 

10,500 6,000 

5,800 

5 5,500 

6 12,000 

6 40,000 

6 15,000 

6 12,000 

6 135,000 


150,000 8,300 

,  22,000 7,500 

,  60,000 6,000 

,  24,000 12,500 

,  15,000 6,500 

,  7,000 24,000 

.  10,000 70,000 

.  7,200 26,000 

.  12,000 45,000 

.  8,500 50,000 

.  20,000 11,000 

.  12,000 12,000 

.  23,200 25,000 

.  15,000 10,000 

.  20,000 24,500 


174 


APPENDIX 


175 


STATEMENT  SHOWING   BACTERIA   CONTENT   OF   SAMPLES  OF   MILK  TAKEN 
FROM   NEW  YORK  MILK  COMMITTEE  STATIONS  AND  EXAMINED  BY 
DR.  NORTH'S  LABORATORY  AND  DEPARTMENT  OF  HEALTH 

(Samples  taken  four  to  ten  hours  after  delivery  of  supply  to  station  and  two  to  three  hours 
after  the  mothers  had  received  their  day's  supply.) 


Number 

OF 

Samples 

Under 
5000 

Bacteria  Content  per  c.c. 

1911 

5000 

TO 

10,00  0 

10.000 

TO 

20,000 

20,000 

TO 

30,000 

30,000 

TO 

50,000 

50,000 

TO 

75,000 

75,000 

TO 

100,000 

OVER 
100,000 

May 

June 

11 

23 
23 
35 
37 
9 

6 

10 

1 

1 
2 

4 
6 
3 

12 

14 

3 

1 

4 

7 

5 

12 

2 

1 

7 
5 
5 
1 

1 

2 
2 
1 

1 
1 
1 

2 

2 

July  

August     

September  .... 
October   

1 

9 
2 
1 

138 

20 

42 

31 

19 

6 

5 

2 

13 

STATEMENT  SHOWING  A  SUMMARY  OF  THE  WORK  OF  NEW  YORK  MILK  COM- 
MITTEE STATIONS,  AS  PER  TABULATION  OF   DAILY  REPORTS 

Period,  May  20  to  October  31,  1911 

Number  of  babies  on  hand  May  20th 634 

Number  of  babies  received 7,951 

Received  by  transfer 291 

Hospital  or  dispensary 24 

Board  of  Health  stations 35 

Other  New  York  Milk  Committee  stations 180 

Other  organizations 52 

Received  by  reference 636 

Hospital  or  dispensary 80 

Board  of  Health  stations 216 

Private  practitioners 193 

Other  New  York  Milk  Committee  stations 27 

Other  organizations 120 

Received  by  canvass 6,538 

Readmitted 486 

Number  of  cases  terminated 3,648 

Refused  to  continue  to  attend 1,657 

Removed 1,053 

Transferred 780 

To  other  New  York  Milk  Committee  stations 367 

To  Board  of  Health  stations 24 

To  hospital  or  dispensary 218 

To  other  organizations 92 

To  private  practitioners 79 

Died 158 

Gastro-intestinal  diseases 79 

Other  causes 79 

Total  number  of  babies  on  hand  October  31st 4,937 


176  INFANT  MORTALITY  AND  MILK  STATIONS 

Statement  Showing  a  Summary  of  the  Work  of  New  York  Milk  Committee  Stations, 
AS  per  Tabulation  of  Daily  Reports, — {Continued.) 

Attendance  at  milk  stations  for  advice 43,739 

Mothers'  first  visits  for  advice 7,921 

Mothers'  revisits  for  advice 35,818 

Well  babies'  first  visits 5,876 

Well  babies'  revisits 28,500 

Sick  babies'  first  visits 1,785 

Sick  babies'  revisits 3,425  39,586 

Home  visits 

To  well  babies'  first  visits 7,463 

To  well  babies'  revisits 12,803 

To  sick  babies'  first  visits 1,551 

To  sick  babies'  revisits 3,778 

To  babies'  (not  found)  first  visits 1,572 

To  babies'  (not  found)  revisits 2,060       29,227 

Visits  of  cooperation,  first  visits . 318 

Visits  of  cooperation,  revisits 206  524 

Number  of  mothers  instructed  first  time 12,401 

Number  of  mothers  instructed  two  or  more  times 9,964 

Total  number  of  mothers  instructed  individually 21,471 

Total  number  of  mothers  instructed  in  class 894      22,365 

Total  new  requests  for  free  milk  (relief) 903 

Number  given  free  milk  (relief) 

Milk  dispensed  (quarts) 420,451 

To  babies 344,694 

To  mothers 36,377 

To  others 33,275 

*Milk  dispensed  (quarts)  from  May  20th  to  May  31st 6,105 

Total  number  of  physicians'  consultations 1,243 

Total  number  of  babies  examined 27,095 

Well  babies  examined  (cases) 23,788 

Sick  babies  examined  (cases) 307 

Number  of  cases  referred  to  hospital  or  dispensary 562 

Surgical  treatment 138 

Medical  treatment 424 

*  Not  itemized. 


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